Express Application:

GENERAL INFORMATION = Required Field  

Please provide as much information as possible.
The more information you provide; the better we will be prepared to serve your needs.

Principal Contact:   Title:  
Phone:   Fax:  
Your Email:      

Legal Business Name:   DBA:  
Business Address:   License State:  
Address Line 2:   Suite:  
City, ST ZipCode:   ,

Describe Business:   # of Locs:  
Fed Tax ID:   % Mail Order:  
State Tax ID:   % Phone Order:  
Business Hours:   % Trade Show:  
Type of Business:   Age of Business:   yrsmth
Date Acquired:   Year Started:  
Est. Card $/Mo.:   Avg. $/Sale:  


OWNER/PRINCIPAL INFORMATION

President/Owner:   Title:  
SSN (Required):   % Ownership:  
Residence Address:   I own:   I rent:
Address Line 2:   Since:  
City, ST ZipCode:   ,
Home Phone:   D.O.B.:  
Prev. Address:    (If less than 3 years)

Co-Owner
(if applicable):		   Title:  
SSN (Required):   % Ownership:  
Residence Address:   I own:   I rent:
Address Line 2:   Since:  
City, ST ZipCode:   ,

Business Location Type of Building:  
How did you find Encore Worldwide Financial?  
Please rank your credit:  
Prior Chapter 7/11/13?      Yes  No Year  

Type of Processing Equipment: (required to process credit card transactions)

Terms:


   

Thank You.
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