Merchant Information Request Form

Merchant Information Request Form

https://safemerchantsolutions.com/
Thank you for contacting us: FIRST ADD OUR USA SUPPORT NUMBER +1 (561) 563-4055 VIA TELEGRAM, SIGNAL, WHATSAPP, OR TEXT MESSAGE. FOR TEAMS: SAFEMS. It is important that we have a chat in order to expedite your approval.
Date:*

MesDíaAño
Merchant Legal Name:*
Merchant DBA Name:*
Street address of DBA:*

DBA Address

City State / Province

Postal / Zip Code
Contact Telephone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Whatsapp Number (If any)
Include country code. Example: +1 (000) 000 0000
Telegram Number (If any)
Include country code. Example: +1 (000) 000 0000
Skype Login (If any)
Website Address:*
Facebook Address
Instagram Address
Is your website integrated with Shopify, Woocommerce, Prestashop?

YesNo
Description of business or goods sold:
Business Type: *

CorporationLLCSole ProprietorshipPartnershipInternational
Date Incorporated:

MesDíaAño
State Incorporated:
Federal Tax ID / EIN (If international enter 9 zeros):*
Business Start Date:

MesDíaAño
Officer's Name:*
Officer's Title:
Contact Email:*
example@example.com
Officer's Home Address:*

Street Address

Dirección de la calle Línea 2

City State / Province

Postal / Zip Code
Driver’s License Number:*
Driver's License State:*
Date Of Birth:*

MesDíaAño
Social Security Number (US Only):*
Passport/ID Number (non US):
Bank Reference:
Name of Bank:
Contact:
ABA Number:
Account Number:
Total Monthly Sales:*
Average Ticket: *
High Ticket:*
Processing History: If yes, please provide 3 months most current processing statements.*

YesNo
What percent of sales will be from:
What percent of sales will be for:
When do you charge the customer?

Upon OrderUpon Shipment
How many days after processing the card, are the Product/Service(s) received?

Immediately1 - 10 days11 - 30 days31 - 90 days
Where will product be sold / service be offered:
Where is the product stored / shipped from:
Description of products or services:
Describe all pricing, membership packages, length of service:
What is your refund policy?*

No RefundsRefund within 30 daysStore CreditOther
Any recurring billing? *

YesNo
Additional Notes
Please upload: Driver's License, Voided Check, Articles Of Incorporation, Processing Statements, Business Bank Statements

Cancelof
For Support Questions - WhatsApp - Telegram - Text Message

+1 (561) 5634055
Should be Empty:

Merchant Information Request Form

Thank you for contacting us: FIRST ADD OUR USA SUPPORT NUMBER +1 (561) 563-4055 VIA TELEGRAM, SIGNAL, WHATSAPP, OR TEXT MESSAGE. FOR TEAMS: SAFEMS. It is important that we have a chat in order to expedite your approval.

Bank Reference:

For Support Questions - WhatsApp - Telegram - Text Message