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Business Information

Business Name

Opersating Address

Address 2

City

State/Zone

Postal Code

Contact E-mail

Website Address

Country of Origin

Country of Primary Operations

Reqired Documentation Checklist

Billing Address

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Voided Check (please upload)

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IRS Form SS-4

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Busniess Licence

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Checking Account

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Owner's Drivers License

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Specialty Licences

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Certificate of Good Standing (for faster approval)

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Business Billing Information

Same as the Business Address

Business Billing Address

Address 2

City

State/Zone

Postal Code

Country

Business Legal Designation

LLC Type 2 -- choose option -- Partnership Corporation Disregarded Entity

C Corp Type -- choose option -- Closely Held Private Public

.. -- choose option -- General Partnership Limited Partnership Sole Proprietorship Sub S Corporate Estate Trust Tax Examption Organization Unincorporated Association Government Other

Other explanation

Specialty License(s) ID

EIN

Year Established

Length of Ownership (yrs & mos)

EBT Services

EBT PIN Debit

EBT Number

Price per Month

Price per Authorization

Additional Services

XBanc Trust Account

Inital Transfer ($)

Mo. Transfer ($)

Cash Incentive

Percent

Wealth Builder

Percent

Interchange Plus

Percent

Per Authorization

Owner Information

Full Name of Primary Owner

Date of Birth

SSN

Telephone

Current Street Address

Ownership Percentage

Yrs. on Address

City

State

ZIP Code

Previous Street Address (if current is under 2 years)

Yrs. on Address

City

State

ZIP Code

Processing information

Previous processor

Refund Policy (none, 30days, exchange only, etc.)

Terminal(s) Brand & Model

Terminal(s) --- select option --- Own Purchase Rent

Quantity

Cost Each

Statement Delivery Preference --- select option --- Email Company Address

Charge Back Delivery Preference --- select option --- Email Company Address

Processing Information

Annual Volume ($)

Average Ticket ($)

Highest Ticket ($)

Projected Monthly Sales

Projected Yearly Sales

Highest Ticket Frequency

According to the Merchant Agreement for Transaction Services, it is necessary for Merchant to provide its banking information to facilitate billing and payments. The Merchant must inform the Processor of any changes to its banking details and accounts. The Processor will not be liable for any funds incorrectly transferred due to a change in banking information or errors that directly resulted from the information provided by Merchant. Merchant authorizes the Processor to debit from the Merchant’s bank account all monthly payments and other amounts owed to the Processor related to the Transaction Services. This authorization shall remain in effect after termination of the authorization shall remain in effect after termination of the Agreement and for as long as Merchant owes any amounts to the Processor. Merchant agrees that the Processor will not be liable for any loss or damage incurred as a result of anything done or not done according to this authorization. If the account is transferred to another branch or the account is closed, and an account is opened at another bank, this authorization shall have the same force and effect as if it originally was directed to that branch or bank. The undersigned Guarantors acknowledge and agree to be bound by all the terms and conditions of this Agreement and unconditionally guarantee the performance of this Agreement. By signing below, Merchant (I) represents that the information provided by Merchant in this Agreement is accurate, complete, and not misleading; (II) acknowledges that Merchant has read and understands this Agreement and Operating Procedures and agrees to be bound by their terms; and (III) authorizes the Processor and its agents to credit and debit the Designated Automatic Funds Transfer Account in accordance with this Agreement.

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Dajem privolu da se moji osobni podaci obrađuju kako slijedi i želim se prijaviti na sljedeće Newsletter liste:

When you sign up for a specific newsletter, we (Connect Marketplace) add your email address to a corresponding mailing list. While it is there, we know that we can contact you by email regarding that topic.

You can always have your email address removed from our mailing lists. There are multiple ways to do it:

Once your account is registered, just sign in and unsubscribe from newsletters in profile settings.
Use the “Unsubscribe” link in our newsletters that you receive.
Send an email to info@connect-mart.com.

We may use a third-party email service (MailChimp) to send newsletters. Some members of our staff can view mailing lists with email addresses. That way they’ll be able to remove your email address from the mailing list, should you request us to do so.

Please note that mailing lists are independent from each other. If you decide not to receive newsletters at all, you’ll have to unsubscribe from all the mailing lists. Even if you do that, you’ll still receive account-related emails (such as order status notifications, password reset emails, and more). It is essential for operating an online store.

If you decide that you no longer want to use our store and would like to have your personal data removed from our database (or if you’d like to get all the personal data associated with your account that we have), please send an email to info@connect-mart.com.

If you believe that your personal data has been misused, you have the right to lodge a complaint with a supervisory authority. We’re obliged by EU General Data Protection Regulation to let you know about this right; we don’t actually intend to misuse your data.

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