Please enable JavaScript in your browser to complete this form.New or Existing CustomerI am a new customerI am an existing customerName *FirstLastBusiness Legal Name (include LLC, Inc. etc.) *Federal Tax ID *Date Company Started *DBA Name ( Doing business as ) *Business Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Phone Number *Latest time of the day your business closes *Business Type (what is being sold)?Retail/Store Card PresentGrocery/Convenience StoreLiquor StoreTobacco ShopRestaurantDeli/Quick Serve RestaurantOnline B2COnline B2BOnline Hemp/DeltaHemp based products storeHair/Nail SalonOtherAverage Ticket Amount (average total customers spend on 1 visit) *Average Monthly Credit Card Sales *Email *Owner SSN *Owner Cell PhoneState Tax ID – NRS POS ORDERS ONLYVoided Check or Bank Letter (jpg, pdf, png, gif)Drivers License (jpg, pdf, png, gif)EIN Letter (from IRS) – NRS POS ORDERS ONLY (jpg, pdf, png, gif)Please Check any Services That May ApplyCredit Card ProcessingCredit Card Processing Zero Rate (Cash DIscount Program)NRS POS w/ Card ProcessingPoint of Sale – Information NeededPreferred contact methodCallTextEmailMaverick Person You are Working With?FirstLastAdditional Comments – Let us know any additional info or questions you have belowSubmit