Merchant Pre-Application




    Owner/Officer/Principal Name *










    Home Phone number




    Mobile Phone number




    Owner/Officer/Principal Home Address















    Percentage of Ownership *

    (required)

    Owner/Officer/Principal Date of Birth *

    (required)


    Driver's License Number *

    (required)

    Date Issued *

    (required)

    Date Expired *

    (required)

    Business Information


    Applying as *


    Sole ProprietorS CorporationClosely HeldPublic CorporationLLC (Limited Liability Corporation)

    Business Legal Name (If Applicable)



    Business DBA (Doing Business As) *



    Business Phone *




    Business Fax




    E-mail of Applicant *



    Business Location *














    Website



    Description of Products/Services offered *



    Project Marketing Material


    Business Information



    Average Daily Sale Amount *



    Average Monthly Sale *



    Card Present %



    Card Not Present %



    Internet/MOTO %



    Checking Routing # *



    Bank Account # *



    Will your business be accepting American Express?




    Disclosure


    Submit my Application



    I agree that the information herein are true and correct


    YES

    Equipment Communication Method





    Wooshcorp, Inc. is a Merchant Service Provider (MSP), an Elavon Global Payments Partner & Registered MSP/ISO of Elavon, Inc. Atlanta, GA.
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