Merchant Application

How did you hear about us?(Required)

Tell us how you heard about us or how you found us or who referred you?

Description of Company(Required)

Provide a brief description of your company

Business Website

Legal Name of Business(Required)

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

Business DBA(Required)

Provide the name or names your doing business as

Business Type(Required)

Sole Proprietorship; LLC; S-Corp; C-Corp; Partnership

Business Federal Tax ID(Required)

Business Contact 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 Business Incorporated in?(Required)

The business must be domiciled in one of the 50 states in the United States.

Operating at a different Physical address than listed?(Required)

Different Physical Address(Required)

DATE BUSINESS OPENED/ACQUIRED:(Required)

Number of Employees(Required)

Customer Sales(Required)

Method of Sales(Required)

Explain Your Other Account Needs(Required)

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

Current Bank Routing # for merchant settlements?(Required)

Current Bank Account # for merchant settlements?(Required)

Have you ever had a payment card processing relationship terminated:(Required)

Have you been placed on MATCH

Who is your current payment provider?(Required)

Who is your POS?(Required)

Type of Terminal you use?(Required)

Who is your current Inventory management provider?(Required)

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

Total sales by credit cards.

Average Ticket Sale(Required)

The average transaction price

Highest Ticket Sale(Required)

The largest transaction amount

Do You Need Lending?(Required)

Lending Story(Required)

Explain about your lending needs

Legal Opinion Reference

Optional if you have a legal opinion to reference, please provide it.

Legal Opinion File Upload

Max. file size: 128 MB.

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

Business Documents Upload(Required)

Max. file size: 128 MB.

If anything is missing from the listed items below it will postpone the application process. Required Documents: * Applicant’s Drivers License * State Business License (if required) * 3 Months Processing Statements * 3 Months Bank Statements * Articles of Incorporation * Copy of Voided Check or alike * COA's / Lab Reports If the files are too large to upload, you must please upload your files to a google drive and send link to: Boarding@leisurepay.io

Principal #1 Percentage of Ownership(Required)

Principal #1 - Street Address(Required)

Principal #1 - City(Required)

Principal #1 - State(Required)

Principal #1 - Zip(Required)

Principal #1 Phone(Required)

Principal #1 Email(Required)

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 another owner with 25% or more ownership? * Please list each individual who directly or indirectly (through any contract arrangement, understanding, relationship, or otherwise) owns 25% or more of the equity interests of the specified legal entity.(Required)

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)

Principal #2 Email(Required)

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 another owner with 25% or more ownership? * Please list each individual who directly or indirectly (through any contract arrangement, understanding, relationship, or otherwise) owns 25% or more of the equity interests of the specified legal entity.(Required)

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 another owner with 25% or more ownership? * Please list each individual who directly or indirectly (through any contract arrangement, understanding, relationship, or otherwise) owns 25% or more of the equity interests of the specified legal entity.(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

Merchant Application

Seamless Payment Processing for High-Risk Businesses