Apply Here - C Mart Technologies

Application

Business Name (DBA = "Doing Business As" Name) *

Business Physical Address *

Business Mailing Address (if different than physical)

Business Phone *

Business Email *

# of Years in Business *

Type of Business *

Corporate/Legal Name (if incorporated)

Corporate Address (if different than physical business)

Corporate Phone

Business Category *

Products/Services Sold *

Currently Accept Visa and MasterCard? *

Current Credit Card Processor Company Name

What type of equipment would you like? *

Average Monthly Credit Card Sales Volume $ *

Average Transaction $ Amount *

Tax ID / EIN # *

*** IMPORTANT ***

Please list all owners with 25% or more ownership below

Owner #1 Name *

First

Last

Owner #1 Title *

Owner #1 Ownership Percentage (Must be 25% or more) *

Owner #1 Residence Address *

Owner #1 Email *

Owner #1 Mobile Phone *

Owner #1 Date of Birth *

Additional Owner #2 Name

First

Last

Owner #2 Title

Owner #2 Ownership Percentage (Must be 25% or more)

Owner #2 Residence Address

Owner #2 Email

Owner #2 Date of Birth

Additional Owner #3 Name

First

Last

Owner #3 Title

Owner #3 Ownership Percentage (Must be 25% or more)

Owner #3 Residence Address

Owner #3 Email

Owner #3 Date of Birth

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