Apply Now – Maverick Midwest

Are you a new or existing customer?

Business Legal Name (include LLC, Inc. etc.) * Please enter the Legal business name *

DBA Name ( doing business as ) *

Business Type (what is being sold)?

Name *

First

Last

Email *

Business Email *

Phone Number *

Business Phone Number *

Ethernet or Wifi Connection? *

Business Daily Open Time *

When the business Open and Close Time.

Expected Monthly Credit Card Volume *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date Business Started *

Federal Tax ID *

State Tax ID (only required if ordering NRS POS) *

Social Security Number (Or Call Your Sales Person)

- Please attach with this form by Emailing us these documents to ([email protected]) *

Copy of the Owner Driver License - REQUIRED
Copy of Void Check/or Bank Letter .( Must Show Account # & Routing #) - REQUIRED
If Ordering NRS POS Also Include: 1.Copy of Tobacco License / Business License 2.PIcture of Credit Card Front & Back (for Boss Revolution Account Setup - $25)

File Upload *

Click or drag files to this area to upload. You can upload up to 10 files.

Please Check any Services That May Apply *

Preferred contact method *