Stuart Merchant Services - New Client Intake Form
Business Name
Business Phone
Business Email
Business Address
Business City, State, Zip
EIN
Business Open Date (mm/yyyy)
Business Website
Requested Monthly Processing Amount
High Ticket
Average Ticket
Business Type
DBA
Owner's Home Address (street)
Owner's Home Address (city state zip)
Owner #1 Legal Name
Owner #1 Date of Birth (mm/dd/yy)
Owner #1 Social Security Number
Owner #1 Phone Number
Owner #2 Legal Name (if only one owner put n/a)
Owner #2 Date of Birth (mm/dd/yy)
Owner #2 Social Security Number
Owner #2 Phone Number
Ownership Percentage Split (#1 xx%, #2 xx%)
Auto Close Time Requested (1 hr after closing is recommended)
Submit for Approval!