Information needed from merchant for Dauntless Pay. Legal Business nameDBA NameBusiness AdressMailing AddressType of OwnershipExempt Payee Yes No 501(c)Excempt Yes No State FeildWebsite URLYears in BusinessTax ID (EIN or SSN if applicable)Business PhoneBusiness FaxCustomer Service PhoneBusiness Email:Customer Service Email:Products or Services Sold:Business Category:Hemp/CBD/MRB License #:License Expiration Date:IRS Notification Paperless Delivery? (Y/N):IRS Notifications Email Address:Beneficial Owner / Signer InformationOwner #1: Personal Guarantor? (Y/N):First Name:Last Name:Title:Ownership %Residential Street Address (No PO Box)Social Security #Date of BirthEmail AddressPhone NumberDrivers License#Driver's License State of Issurance:Authorized Signer (If not Beneficial Owner)First NameLast NameTitleResidential Street Address (No PO Box)Social Security #Date Of BirthEmail AddressPhone NumberDrivers LicenseDriver’s License State of IssuanceBanking InformationBank NameRouting NumberAccount NumberBank Branch AddressBank Branch PhoneCard Processing InformationAccepted Cards Before? (Y/N):If yes, Processor Name:Prior Terminations? (Y/N):If yes, Please Explain:# of Locations:If affiliated with an existing account, please provide existing merchant ID #:Annual Volume $:Monthly. Volume $:Monthly. Volume $:Annual Amex Vol. >$1M? (Y/N):Avg. Ticket $:High Ticket $:Daily Auths #:Card Types Requested: All Credit Cards All Credit & PIN-Based Debit Cards PIN-Based Debit Cards Only Credit Card Processing Methods (if Applicable) – Row Total Must Equal 100%Store Front/Swiped %:Internet %:MOTO %:Total:Customer Transaction Type – Row Total Must Equal 100%Business to Consumer (“B2C”)Business to Business (“B2B”) %:Total:SITE SURVEY: FULFILLMENT / MARKETINGBill Before Shipping? (Y/N/NA):If Yes, how many days?Refund Policy: Full Refund Exchange Only None Seasonal Business? (Y/N):If yes, Indicate Months Active: All Months Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Description of Advertising Methods:TRADE REFERENCESTrade Name:Account Number:Phone Number:Product Sold:
