Cannabis Merchant Application

How did you hear about us?(Required)

Business Website

Legal Business Name(Required)

TAX FILING NAME, as it appears on your income tax return

Doing Business As (DBA)(Required)

Provide the name or names your doing business as

Business Type(Required)

Business Federal TAX ID(Required)

Business Email Address(Required)

Business Phone Number(Required)

Legal Business STREET Address(Required)

Legal Business City(Required)

Legal Business State(Required)

Legal Business Zip Code(Required)

What state is the business incorporated in?(Required)

The business must be domiciled in one of the 40 states and the District of Columbia in the United States where Cannabis is legal.

Is the physical Address the same as the Legal address?(Required)

Provide each address the business operates from(Required)

Date Business Opened / Acquired(Required)

Number of Employees(Required)

Is business publicly traded, registered with the SEC, or not-for-profit?(Required)

If publicly traded [NYSE or NASDAQ], list ticker

Is your primary institution aware that you are an MRB engaged in activity that is subjected to the Cole Memo?(Required)

Who is your Cannabis Compliance Tracking System provider?(Required)

Provide Tracking System Name(Required)

Is there an ATM onsite(Required)

Does this company offer Delta-8 Products?(Required)

Does this company offer Kratom-derived products?(Required)

What is the current Bank Name for your deposit?(Required)

Current Bank Routing # for merchant deposits?(Required)

Current Bank Account # for merchant deposits?(Required)

Have you ever had a payment card processing relationship terminated: (have you been placed on MATCH)(Required)

Who is your current payment provider?(Required)

What POS are you currently using?(Required)

List your point of sale provider

Are any beneficial owners a Politically Exposed Persons (PEP)?(Required)

Does your company accept cash?(Required)

Does your company accept bitcoin or other non-fiat methods of payment?(Required)

How many terminals will you need?(Required)

Each device is $400, pricing covers ground shipping only.

Who is your debit provider?(Required)

Do you operate a cashless ATM that mimics a real ATM?(Required)

What is the total gross monthly processing amount?(Required)

Highest Ticket Amount(Required)

What is the highest ticket amount you anticipate?

Average Ticket Amount(Required)

Do You Need Lending?(Required)

Lending Story(Required)

Explain about your lending needs

Legal Opinion Reference(Required)

Optional if you have a legal opinion, please upload it.

Legal Opinion File Upload(Required)

Max. file size: 128 MB.

Optional if you have a legal opinion, please upload it.

Upload Business documents(Required)

Max. file size: 128 MB.

If anything is missing from the listed items below it will postpone the application process. * Copy of State Business License (if required) * 3 Months Processing Statements * 3 Months Bank Statements * Articles of Incorporation * Copy of Voided Check or Bank letter * Copy of Cannabis License * Operational Agreement (to include signatures and Ownership Schedule) * Full Articles of Incorporation/Organization * Copy of Fictitious Name filing (if applicable) * EIN confirmation letter from IRS (Must be filed document – cannot be application) * Copy of all Country, State, County, City, etc. Cannabis License/Permits/Registrations If applicable, provide any notices of violations, suspensions, or investigations by the appropriate state/local authority.

Principal #1 Percentage of Ownership(Required)

Please list each individual who directly or indirectly (through any contract arrangement, understanding, relationship, or otherwise) owns 10% or more of the equity interests of the specified legal entity.

Principal #1 - Street Address(Required)

Principal #1 - City(Required)

Principal #1 - State(Required)

Principal #1 - Zip(Required)

Principal #1 Phone(Required)

This will be used to send status updates on your application.

Principal #1 Email(Required)

This will be used to send your agreement for signature, via DocuSign, and to communicate other important information regarding your application.

Principal #1 Date of Birth(Required)

Principal #1 SSN(Required)

Principal #1 Identification Upload(Required)

Max. file size: 128 MB.

**Ensure your ID document is not expired** Acceptable Documents: Drivers License Identification Card Passport

Is there any other owners with 10% or more?(Required)

Please list each individual who directly or indirectly (through any contract arrangement, understanding, relationship, or otherwise) owns 10% or more of the equity interests of the specified legal entity.

Principal #2 Percentage of Ownership(Required)

Principal #2 First Name(Required)

Principal #2 Last Name(Required)

Principal #2 - Street Address(Required)

Principal #2 - City(Required)

Principal #2 - State(Required)

Principal #2 - Zip(Required)

Principal #2 Phone(Required)

This will be used to send status updates on your application.

Principal #2 Email(Required)

This will be used to send your agreement for signature, via DocuSign, and to communicate other important information regarding your application.

Principal #2 Date of Birth(Required)

Principal #2 SSN(Required)

Principal #2 Identification Upload(Required)

Max. file size: 128 MB.

**Ensure your ID document is not expired** Acceptable Documents: Drivers License Identification Card Passport

Is there any other owners with 10% or more?(Required)

Please list each individual who directly or indirectly (through any contract arrangement, understanding, relationship, or otherwise) owns 10% or more of the equity interests of the specified legal entity.

Principal #3 Percentage of Ownership(Required)

Principal #3 First Name(Required)

Principal #3 Last Name(Required)

Principal #3 - Street Address(Required)

Principal #3 - City(Required)

Principal #3 - State(Required)

Principal #3 - Zip(Required)

Principal #3 Phone(Required)

Principal #3 Email(Required)

Principal #3 Date of Birth(Required)

Principal #3 SSN(Required)

Principal #3 Identification Upload(Required)

Max. file size: 128 MB.

**Ensure your ID document is not expired** Acceptable Documents: Drivers License Identification Card Passport

Is there any other owners with 10% or more?(Required)

Principal #4 Percentage of Ownership(Required)

Principal #4 First Name(Required)

Principal #4 Last Name(Required)

Principal #4 - Street Address(Required)

Principal #4 - City(Required)

Principal #4 - State(Required)

Principal #4 - Zip(Required)

Principal #4 Phone(Required)

Principal #4 Email(Required)

Principal #4 Date of Birth(Required)

Principal #4 SSN(Required)

Principal #4 Identification Upload(Required)

Max. file size: 128 MB.

**Ensure your ID document is not expired** Acceptable Documents: Drivers License Identification Card Passport

Cannabis Merchant Application

Seamless Payment Processing for High-Risk Businesses