Merchant Application

Business Name:

AMG Application.
901 Marquette Ave Suite
Minneapolis MN 55401

Include all the following required items with application:
APPLICATION WILL NOT BE PROCESSED UNTIL COMPLETE.

Attached

Required Documents

1. Signed copy of Merchant Application.

2. Scanned copy of Driver's License:

3. Scanned copy of either of the following:

     

4. Certificate of Incorporation.

5. Fictitious Name Filing/DBA (If applicable).

6. Utility Bill (Must be from a public utilities company).

7. Last three (3) months operating business account statements. (If new business, provide principal's banking statements).

8. Last three (3) months ACH/Check 21/Credit Card processing statements.

9. Voided preprinted check and deposit slip (Supply letter from bank affirming account ownership if not available)

10. Fulfillment Information and/or Sales script.

Additional Items Required (If Processing Over $50,000.00 Per Month)

11. Annual Financial Statements.

12. Last two (2) Federal Income Tax Returns

13. Third Party Recording Login.

14. Copy of company business model.

IMPORTANT INFORMATION ABOUT OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law (Patriot Act) requires all financial institutions to obtain, verify, and record information that identifies each person who opens an Account. Identity verification also helps to protect you and us from fraud.

What this means for you: When you open an Account, we will ask you for your name, address, date of birth, and other information that will allow us to identify you. We must also ask for driver's license information or other identifying documents.

Sales Information

Reseller Name:
Sales Agent Name:
Processing Requested:

Business Information

Legal Business Name:
Company DBA:
Business Address Line 1 (No P.O. Box):
Business Address Line 2:
City:
State:
Zip:
Country:
Business Phone:
Business Fax:
Customer Service Email:
Business URL:
Customer Service Number:
Customer Service Hours of Operation:
State of Incorporation:
Incorporation Date:
EIN #:
Years in Business:
Type of Ownership:

 Business Premises:

Principal 1 Information (if there are multiple owners, use information for owner with largest share of ownership)

Business Ownership %:
Home Ownership:
First Name:
Middle Initial:
Last Name:
Residence Address Line 1 (No P.O. Box):
Residence Address Line 2:
City:
State:
Zip:
Country:
Residence Phone:
Mobile Phone:
Residence Fax:
Email:
Date of Birth (MM/DD/YYYY):
Social Security Number:
Driver's License #:
Driver's License State:

Principal 2 Information

Business Ownership %:
Home Ownership:
First Name:
Middle Initial:
Last Name:
Residence Address Line 1 (No P.O. Box):
Residence Address Line 2:
City:
State:
Zip:
Country:
Residence Phone:
Mobile Phone:
Residence Fax:
Email:
Date of Birth (MM/DD/YYYY):
Social Security Number:
Driver's License #:
Driver's License State:

Check Processing

Do you currently utilize Check21 or ACH?:
Number of Transactions / Day:
Number of Transactions / Day:
Average Transaction Amount:
Number of Returns / Month:
Average Return Amount:

Credit Card Processing

Do you currently process credit cards?:
Number of Transactions / Day:
Number of Transactions / Day:
Average Transaction Amount: $:
Number of Transactions / Day:

Bank Account Information

Bank Name:
Name on Account:
Bank Routing Number:
Account Number:

Merchant Website Details

Site URL:
Account Number:
Descriptor (Pay to the Order of):
Recurring:
Describe Product /Service
Customer Service #:
Service Provider:
Is a Merchant Certificate utilized?

Certificate #:

   Certificate Issuer: Expiration

   Expiration Date:

Certificate Issuer: Expiration
Describe refund policy
Type of authorization retained
How will transactions be initiated?
Site2 URL:
Customer Service :
Descriptor (Pay to the Order of):
Recurring:
Describe Product /Service
Customer Service #:
Service Provider:
Is a Merchant Certificate utilized?

Certificate #:

   Certificate Issuer: Expiration

  Expiration Date:

Certificate Issuer: Expiration
Describe refund policy
Type of authorization retained
How will transactions be initiated?

Marketing Information

How do you market your product?
If other, describe:

Shipment and Fulfillment Information

What are the shipment fees per order?

Delivery Method:

Do customers get a reservation code enabling them to track the product?

Do you offer insurance in case the product is damaged?

Do you use a fulfillment house?
Name:
Phone Number:

Risk Questionnaire

Will you be processing ONLY US transactions?
If No, list all countries:
Are there any states/countries which are blocked?
If YES, please explain.
How do you handle fraud issues? Please detail any Anti-Fraud tools used.
If you use affiliate programs, are they involved in the processing?
Do you allow P.O. box as address field?
If NO, how do you control it?
Are email receipts sent upon purchase confirmation?
How do you verify customers' identification?
Does your website have a customer login?(If YES, a temporary login must be provided.)
Username:
Password:

Business and Personal References

Name:
Company Name:
Phone Number:
Name:
Company Name:
Phone Number:
Personal Reference Name
Phone Number:

You understand by signing below AMG INC will receive, collect and hold personal or non-public information about the merchant including but not limited to: the merchants name, address, telephone number, e-mail address, social security number and/or tax identification number, credit history, or the purpose of considering eligibility for the AMG Services. AMG INC may also submit such information to Financial institutions in orderto administer services for the merchant.



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