TRACK-N-PAY MERCHANT APPLICATION

Legal Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

Main Contact Email Address

example@example.com

Corporate Phone Number

DBA (If different from legal name)

Federal Tax ID*

Length of Ownership

Business Start Date

Date

Website

Type of Business (select all that apply):

RETAIL LOCATION #1

Lease or Own

Landlord Name

Telephone

Merchant Location

Shopping CenterRetail StorefrontResidence MobileOther

Area Zoned

CommercialResidentialIndustrial

Years at Location

Location Address

City

State

Zip Code

Location Main Phone Number

Fax Number

RETAIL LOCATION #2

SELECT ONE

LEASEOWNOther

Landlord Name

Telephone

Merchant Location

Shopping CenterRetail StorefrontResidence Mobile MerchantOffice Building

Area Zoned

CommercialResidentialIndustrial

Years at Location

Location Address

City

State

Zip Code

Location Main Phone Number

Fax Number

RETAIL LOCATION #3

SELECT ONE

LeaseOwnOther

Landlord Name

Telephone

Merchant Location

Shopping CenterRetail StorefrontResidence MobileOffice Building

Area Zoned

CommercialResidentialIndustrial

Years at Location

Location Address

City

State

Zip Code

Location Main Phone Number

Fax Number

OWNERSHIP PERCENTAGE

Contact Email Address

example@example.com

Name of Owner

Title

Address

Street Address

Street Address Line 2

CityState

Zip Code

Social Security

Equity Ownership

Date of Birth

Date

Phone Number

Driver’s License

Driver's License State

If the owner does not hold 51% equity please provide additional ownership information below

Title

OWNERSHIP PERCENTAGE

Contact Email Address

example@example.com

Name of Owner

Home Address

City

State

Zip Code

Social Security

Equity Ownership

Date of Birth

Date

Phone Number

Driver’s License

Driver's License State

Name of Bank

Name of Bank Manager

Account Number

Routing Number

Address

City

State

Zip Code

Companies bank has a verified cannabis program

YesNo

Name of company providing cash transport

Maximum Single Debit Item

Maximum Single Credit Item

Maximum Single Debit Item

Maximum Single Credit Item

Average Gross Sales for last 3 months

Expected Gross Income this year

Gross Income last year

Average Gross Sales for last 3 months

Expected Gross income this year

Gross Income last year

EIN LETTER - Taxpayer Identification and/or employer ID*

OPERATING AGREEMENT

BYLAWS, MINUTES AND/OR RESOLUTIONS AUTHORIZING WHO MAY OPEN AND SIGN ON ACCOUNTS

LICENSE(S) TO DO BUSINESS (Business registrations / Tax Licenses)

ARTICLES OF ORGANIZATION

MOST RECENT 2 YEARS OF COMPNAY FINANCIAL STATEMENTS

THREE MOST RECENT CONSECUTIVE COMPANY BANK ACCOUNT STATMENTS

COPY OF OWNER(S) DRIVERS LICENSE

COPY OF PRE-PRINTED VOIDED CHECK WITH COMPANY NAME/ADDRESS

NOTICE AND EXPLANATION OF ANY LEGAL ISSUES RELATED TO COMPANY

MERCHANT APPLICATION

CORPORATE/LEGAL INFORMATION

RETAIL LOCATION(S) INFORMATION

OWNERSHIP INFORMATION

BANKING INFORMATION

SALES ACTIVITY

BUSINESS TRANSACTION ACTIVITY

SUPPORTING DOCUMENTS