Business Credit Card Application

Additional Owner

If you have any additional owners, please state all information that is listed above.

Business Financial Information

Taxpayer Identification Number (TIN)

EBITDA (Net Income + Interest, Income Taxes, Depreciation and Amortization)

Annual Business Debt Payments

Customer Due Diligence

I, the Applicant/Co-applicant, am registered with Financial Crime Enforcement Network (FinCEN) in connection with a Money Service Business (MSB) *

Yes

I, the Applicant/Co-applicant, own or operate a privately owned Automated Teller Machine (ATM) *

Yes

I, the Applicant/Co-Applicant, engage in internet gambling activity *

Yes

I, the Applicant/Co-applicant, participate directly or in-directly in the production, manufacturing, or distribution (wholesale or retail) of recreational or medical marijuana *

Yes

Authorized Officer *

Terms and Conditions *

I acknowledge, as the Authorizing Officer, that I have read and agreed to our Agreement, the Terms & Conditions stated within this application, and the Pricing detailed within this application, and agree to conduct this transaction electronically.

I acknowledge that additional financial documents might be required and requested depending on credit line requested.

Business Credit Card Application

Company Information

Principal or Owner Information

Business Financial Information

Customer Due Diligence