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)

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    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

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    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?


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    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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