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First Name
*
Last Name
*
Doing Business As (dba), if applicable
Legal form of company (type)
*
Inc
LLC
LP
LLP
Sole Proprietorship
Other
Business address
Owner or officer
Date business was established
*
Official owner
*
Business phone number
*
Mobile phone number
*
Email address of contact person
*
Products/services sold
*
URL(s) where products will be sold
*
Description of core business, target markets and countries where goods are sold
*
Annual Revenue
*
Average ticket amount
*
Monthly credit card sales
*
Number of monthly transactions
*
Chargeback % last 6 months
*
Current processor
*
Comments or additional information