Cannabis Merchant Pre-Qualification Application

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Complete the form on this page to receive an evaluation for approval from one of our payment specialists.

1 Business Information
2 Owner Information
3 Bank Information
4 Transaction Information

Business Information

Legal Name*

Legal Business Address*

Street Address Address Line 2 City State ZIP Code

Doing Business As (DBA) Information

DBA Address

Check this box if DBA Address is same as Legal Business Address.

DBA Name

DBA Address

Street Address Address Line 2 City State ZIP Code

Premise Type

Type of Ownership

Number of years at current residence

Number of months at current residence

Federal TAX ID/EIN

Website URL

Business Phone Number*

Contact Email Address*

Return & Refund Policies*

Description of Products/Services*

Get approved!

Complete the form on this page to receive an evaluation for approval from one of our payment specialists.

1 Business Information
2 Owner Information
3 Bank Information
4 Transaction Information

Owner Information

Full Name*

First Middle Last

Social Security Number*

Date Of Birth*

% Of Business Owned*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone

Length At Current Residence

Length At Current Residence - Years

Length At Current Residence - Months

Do you want to add a co-owner?

Check this box if you want to add a co-owner's information.

Co-Owner Information

Full Name

First Middle Last

Social Security Number

Date Of Birth

% Of Business Owned

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Length At Current Residence

Length At Current Residence - Months

Length At Current Residence - Years

Get approved!

Complete the form on this page to receive an evaluation for approval from one of our payment specialists.

1 Business Information
2 Owner Information
3 Bank Information
4 Transaction Information

Bank Information

Bank Name

Routing Number

Account Number

Get approved!

Business Information

Get approved!

Owner Information

Co-Owner Information

Get approved!

Bank Information

Get approved!

Transaction Information

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