APPLICATION FOR MERCHANT CARD PROCESSING -Dylish Software
Who is your sales rep?
*
Legal Name of Business (25 characters max)
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Business Name
Business Address
*
City, State, Zip
*
Email Address for notices
*
example@example.com
Business Website Address
Ex: www.dylish.com
Business Phone Number
*
-
Area Code
Phone Number
Length Owned/ Years of operation
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Describe products or services sold
Ex: Bakery, flower shop, Thai food
Legal Name (as shown on your income tax return or SS-4 Form, up to 40 characters)
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Taxpayer Identification Number: Must be 9 digits (EIN or SSN)
*
Taxpayer Identification Number
*
EIN
Social Security Number
Type of Ownership
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Sole Proprietorship
Corporation
LLC
Partnership
Ltd Liability Partnership
Government Entity
Trust
Political Organization
Non Profit Corporation
Full name of owner (as shown on Government ID)
*
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Percent Owned (%)
*
Residential Address, City, State, Zip
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Owner's Mobile Phone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please upload a copy of your ID
*
Browse Files
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of
SSN
*
U.S. Person Non-U.S. Person
*
U.S. Person Non-U.S. Person
Average Credit/Debit Transaction (Ticket) Amount
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Total Credit/Debit Monthly Sales
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Total (must equal 100%) 100
*
Bank Name
*
Routing Number
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Bank Account Number
*
Please upload a copy of a voided check to verify banking information
*
Browse Files
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Choose a file
Cancel
of
Dylish Processing Percentage Rate
(as discussed with your representative)
Merchant Signage
Owner's Full Name
*
Title
*
(owner, manager, member)
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Continue
Continue
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