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AzulaiPay Merchant Application.'
Personal Information
Full Legal Name
*
Email Address
*
Phone Number
*
Personal Address
*
Date of Birth
*
SSN
*
Upload Driver's License
*
Click to choose a file or drag here
Business Information
Business Name
*
Business Address
*
DBA
*
DBA Address
*
Business Industry
*
Products/Services Sold
*
Business Start Date
*
Business Website
*
Federal Tax ID
*
Banking Information
Bank Name
*
Account Number
*
Routing Number
*
Upload 3 Most Recent Bank Statements
*
Click to choose a file or drag here
Processing Information
Average Transaction Amount
*
Highest Transaction Amount
*
Monthly Volume Processed by Credit Card
*
Terminal/Gateway Info
*
Upload 3 Most Recent Processing Statements
*
Click to choose a file or drag here
Submit
