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WFJ Registration

Business Information

Legal Name of Business:

DBA Name:

Date of Business Established:

Taxpayer Indentification Number:

Business Phone Number:

Type of Business:Description:

Physical Address

Address (No P.O. Boxes):

Unit#:

City:

State:

Zip:

Corporate Address (If Different than Physical Address)

Address (No P.O. Boxes):

Unit#

City

State

Zip

Business E-mail (For notices and all other communication):

Business website Address if applicable:

Principal Information List name one Principal owner position held with company

Last Name:

First Name:

Middle Name:

Title:

Ownership Percentage:

Date of Birth:

Social Security Number:

Home Phone:

Principle Home Address

Address:

Unit#:

City:

State:

Zip:

Driver’s License Number:

(Attach copy to Application)

Start issuing Driver’s License:

License Expiration Date:

Owner’s Email Address:

Cell Phone Number:

Attachment Required

Driver’s License:

Voided Check or Bank Letter:

FSN No. (If you process EBT.Foot Stamp):

Banking Information

Name of Bank or Financial Institution:

Address:

Contact Name & Phone:

Business Checking account Number:

Business Checking routing Number:

Credit Card Terminal:

Encryption:

Gas Station POS:

Installation Date:

Other Fleet Cards:

Site ID #:

Pricing:

Member Operated Location:

Other Notes:

Leave this empty:

Please Confirm full name and signature.

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Welcome to WFJ Merchant Services https://wfjmerchantservices.com

Timestamp

Audit

June 26, 2020 1:49 pm GMT

WFJ Registration Uploaded by Wfj Webadmin - support@autowebtech.com IP 110.227.76.232