Legal Name
Legal Address
Legal Address Address Line 1
Legal Address Address Line 2 (optional)
Legal Address City
Legal Address State
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Legal Address Zip Code
DBA Name
Business Address
Same as my Legal Address
Business Address Line 1
Business Address Line 2 (optional)
Business Address City
Business Address State
Business Address Zip Code
Tax ID (9 digits)
Ownership Type
—Please choose an option—SoleProprietorPartnershipGovernmentLLC C CorpNonProfitTrust Or EstateNon US EntityC CorporationS CorporationLLC Disregarded EntityLLC PartnershipLLC S CorpLLC SoleProprietor
Phone
Email
Ownership Start Date
Owner Name
Owner Address
Owner Address Line 1
Owner Address Line 2 (optional)
Owner Address City
Owner Address State
Owner Address Zip Code
Date of Birth
SSN
Average Transaction Amount
Average Monthly Sales
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