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:
*
/
Mes
/
Día
Año
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.
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?
Yes
No
Description of business or goods sold:
Business Type:
*
Corporation
LLC
Sole Proprietorship
Partnership
International
Date Incorporated:
/
Mes
/
Día
Año
State Incorporated:
Federal Tax ID / EIN (If international enter 9 zeros):
*
Business Start Date:
/
Mes
/
Día
Año
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:
*
/
Mes
/
Día
Año
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.
*
Yes
No
What percent of sales will be from:
What percent of sales will be for:
When do you charge the customer?
Upon Order
Upon Shipment
How many days after processing the card, are the Product/Service(s) received?
Immediately
1 - 10 days
11 - 30 days
31 - 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 Refunds
Refund within 30 days
Store Credit
Other
Any recurring billing?
*
Yes
No
Additional Notes
Please upload: Driver's License, Voided Check, Articles Of Incorporation, Processing Statements, Business Bank Statements
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For Support Questions - WhatsApp - Telegram - Text Message
+1 (561) 5634055
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