Merchant Services

Please complete to provide the info I need to build your Merchant Services Agreement. Once I have this info I will build and send you our agreement to review and sign electronically. If you have any questions please give me a call at 940-600-3311 or send me an email noah.farnham@fiserv.com.

Legal Name Of The Business

Federal Tax ID (EIN #)

Doing Business As Name

Choose Your Business Structure

Business Phone #

Email Address

Physical Store Address (NO PO BOXES)

City

Zip Code

Do You have a different mailing address?

Date Your Business Started

The Name Of Your Bank

Your Bank's Routing Number

Your Bank Account Number

Position Title Of Agreement Signer

First and Last Name of Agreement Signer

Home Address

Home Address City

Zip

Birth Date of Signer

Last 4 of Social Security #

% Ownership

Are There Any Other Owners With 25% Ownership or more?

Pre Application Form By Noah Farnham

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Pre Application Form