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Merchant Information
Legal Name of Business DBA(Doing Business As)
Business Address City State              Zip
Business Telephone Merchant Email
Product/Services Sold Business Start Date (MM/DD/YYYY)
Tax Filling Name Federal Tax ID #
Principal's Name Ownership % Title
Home Address City State              Zip
Home Telephone / Cell Phone Date of Birth(MM/DD/YYYY) SSN
Driver's license No Driver's license State Exp Date (MM/DD/YYYY)
Settlement Account
Bank Name Routing # Account #
Marketing Method
MC/VI/DS Monthly Volume      $ Average Sales Amount      $
Amex Monthly Volume            $ Highest Sales Amount        $
Swipe Volume                           %
Equipment / Software
In order for Arbelsoft to procure the lowest possible rates and fees for our merchants, a 2 year agreement is necessary Should the applicant be able to provide a statement from their previous processor, Ignite will meet or beat the rates with a copy of your statement at any time. I hereby authorize : Arbelsoft Inc./Ignite Payments to order a credit report on my behalf.
Applicant's Name   Date  
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