Merchant Services Questionnaire
    Office: (877) 224-5699
    Fax:(877) 607-2525
    www.whitestonefund.com

    We require the following:
    Copy of Driver’s License
    Copy of Voided Check

    Agent:

    BUSINESS INFORMATION

    Legal Business Name:

    Business DBA (If different):

    Business Tax ID:

    Business Start Date:

    Business Address:

    City:

    State:

    Zip:

    Mailing Address:

    City:

    State:

    Zip:

    Contact Name:

    Business Type:Soles PropCorpLLC

    Phone Number:

    Building Type:

    Location:

    Email Address:

    Owner’s Name y Title:

    Owner’s Address:

    City:

    Zip:

    Owner’s DOB:

    Owners Social

    DL#

    Owner’s Percent of Ownership of Business:

    Monthly Volume: $

    Average Ticket: $

    High Ticket: $

    Products/Services Solid:

    Currently Processing?: , If yes, please provide most recent processing statement. Transaction Type (Retail Swiped, Mail-order/Telephone-order, or eCommerce):

    Swipe:%

    Keyed:%

    Internet:%

    Website (if applicable):

    What payment gateway, point-of-sale, or terminal is used to process payments?:

    Cash Discount:SiNO

    Rate:

    Tran Feet:

    EBT #:

    Monthly Fee: $

    Terminal:

    Ship to:

    Batch Close:

    Print Name

    Date

    Co Applican

    Date

    Upload Files

    Signature