Business Information

Business Name (dba):

Business Legal Name:

Business Email:

Verify Business Email:

Business Phone #:

Business Website:

Owner Information

Primary Owner Name:

Primary Owner Email:

Primary Owner Phone #:

  Primary Owner % Ownership

Are there Multiple Owners with at least 10% Equity? No Yes

Additional Owner(s) Information

Owner #2 Name:

Owner #2 Email:

Owner #2 Phone #:

  Owner #2's Ownership %:

Operation Information

  Number of Locations:

  # of POS Terminals:

  Avg Monthly Volume

  Avg Ticket Size

  Name of Software(s) Currently Used:

  New Software

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Notes

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