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Publication Title | CBD Domestic Merchant Application

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Search Completed | Title | CBD Domestic Merchant Application
Original File Name Searched: cbd_domestic_merchant_application.fim_1130.pdf | Google It | Yahoo | Bing



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Text | CBD Domestic Merchant Application | 001



CBD Domestic Merchant Application
Please provide the following documents to support the approval of your merchant account.
☐ Application (attached)
☐ Voided Check / Bank Letter
☐ EIN Document
☐ Most recent financials or corporate tax returns
☐ CBD Certificate, stating where the product has come from and that the CBD’s contents are legal for the distribution in the United States. ☐ Provide Legal Opinion that CBD’s are legal to sell in the United States. (We can direct you to a Firm to obtain this, if needed)
COMPANY PROFILE
Merchant Name (DBA or Trade Name): Location Address:
City, State:
Contact Name:
Telephone Number:
Federal Tax ID (EIN No.):
Have you ever filed for a Bankruptcy?
☐ Yes ☐ No If yes, when? ______________________
OWNERSHIP PROFILE (must equal 100%) Principal #1 – Name:
Date of Birth:
Home Address:
Principal #2 – Name:
Date of Birth:
Home Address:
BUSINESS PROFILE
URL(s):
Information to appear on Cardholder’s Statement (Max 20 characters, including phone number and spaces):
Description of products/services sold:
Please list all the banks you may have a pending application:
Does the signing Principal have other active corps that gave processed or are currently processing? ☐Yes ☐No If yes, please list banks/processors:
Are you currently accepting payments?
☐Yes ☐No
Method of Acceptance: MOTO_______% Internet_______% Swipe______% (must equal 100%)
Estimated Monthly Volume: $_____________
Refund Policy? ☐ Yes ☐ No Please Describe:
When does, the payment take place?
☐Upon Purchase ☐Upon Download ☐Upon Delivery ☐Other_______ Are you currently processing transactions? ☐ Yes ☐ No
In which currency are your product/service sold?
Payment Solution
Applying for: ☐ VISA ☐ MasterCard ☐ American Express
ZIP Code:
Email Address:
1-800 Support Number:
☐ Articles of Incorporation
☐ 3-mnths corporate bank statement
☐ Utility Bill (as proof of address) ☐Complete Questionnaire Pg. 3 (Attached)
☐ Driver’s License / Passport (clear & color copy) ☐ 3-mnths processing statement
☐ Proof of Domain Ownership
☐Website Requirements are meet on Pg. 2
Country:
Corporate Legal Name:
Corporate Address:
City, State:
Technical Contact:
ZIP Code:
Country:
Email Address:
Incorporation Date:
Business Type: ☐ Corporation ☐ Partnership ☐ LLC ☐ Sole Proprietor ☐ Other
Length of time in business?
Number of Employees:
Social Security #:
Social Security #:
Title:
Title:
ID Type:
City, State:
ID Type:
% Owned:
Telephone Number:
ZIP Code:
Telephone Number:
ID #:
ID #:
Email Address:
% Owned:
Country:
Email Address:
City, State:
Average Ticket: $_________________
ZIP Code:
Current Gateway:
Percentage of Transactions: US________% Europe________% Asia________% (must equal 100%) Rest of the World________%
Country:
Current Acquirer:
Reason for leaving current acquirer?
Highest Ticket: $______________
Average CB Ratio:
Recurring Services? ☐ Yes ☐ No Please Describe:
Delivery time of service/goods? Are packages tracked? ☐Yes ☐No ☐ Immediately ☐Within 4 Weeks ☐Within 5-14 Weeks
Is a Fulfillment House used? ☐ Yes ☐ No
(If yes, please provide Fulfillment Agreements)
In which currency, would you like your settlement to your bank account?
Service Type
Applying for: ☐ Credit Card ☐ eCheck ☐ ACH ☐ Debit Card ☐ Other

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cbd-domestic-merchant-application-001
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