| 3.8 Merchant Application: Step 2

Step 2: Personal Information
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Please enter your personal information including your Social security (SSN) number or Tax ID number. If your personal address is different from your business address, you may change it here.

Legal Full Name :
Please use proper capitalization.
Title :   

Social Sec. # :



Please enter as: 333-33-3333  NO Tax ID's!
this must be your social security #

Alternate Phone :   
Ownership % :   
Primary signer must  assume 51% or greater.
Years in Business :   
Months in Business :

Home Address :


No P.O. Boxes! The bank will not process an
application based on P.O. Boxes.

City :   
State :   
ZIP Code :
Type of Ownership :   
Date of Birth  :    MM/DD/YYYY

Note that this information is required for the Patriot Act

Driver's License #   
Driver's License State :   
Date License Issued :    MM/DD/YYYY
Date License Expires :    MM/DD/YYYY




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