Business Credit Card Application

Choose business type

Sole Proprietor

Partnership

Corporation

LLC

Requested Credit Limit *

Principal or Owner Information

Last Name

First Name

Middle Name

Ownership Percentage

Title

Gross Annual Income

Date of Birth

Home Address

City

State *

Zip Code *

Home Phone

Years Involved

Own / Rent / Other

Monthly Payment

Business Financial Information

Taxpayer Identification Number (TIN)

Total Assets

Total Liabilities

EBITDA (Net Income + Interest, Income Taxes, Depreciation and Amortization)

Annual Sales

Annual Business Debt Payments

Customer Due Diligence

I, the Applicant/Co-applicant, am registered with Financial Crime Enforcement Network (FinCEN) in connection with a Money Service Business (MSB) *

Yes

I, the Applicant/Co-applicant, own or operate a privately owned Automated Teller Machine (ATM) *

Yes

I, the Applicant/Co-Applicant, engage in internet gambling activity *

Yes

I, the Applicant/Co-applicant, participate directly or in-directly in the production, manufacturing, or distribution (wholesale or retail) of recreational or medical marijuana *

Yes

Terms and Conditions *

I acknowledge, as the Authorizing Officer, that I have read and agreed to our Agreement, the Terms & Conditions stated within this application, and the Pricing detailed within this application, and agree to conduct this transaction electronically.

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Business Credit Card Application

Company Information

Principal or Owner Information

Business Financial Information

Customer Due Diligence