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Page 1 of 3

New Client Information Form

Please Answer All Sections As Completely As Possible
Services Requested


Section 1 - Business Information

As Appears on Tax Return

Billing Address

Physical Address

The email address where settlement notifications, return notifications, etc. will be sent.

The email address where invoices and statements should be sent.

The email address that would be displayed for your customers to contact you.

As Appears on Tax Return

Section 2 - Primary Contact:


Page 2 of 3

Section 3 - Owner / Signatory Information

Section 4 - Bank Settlement Information

Section 5 - Trade References
Trade Reference 1

Trade Reference 2

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Section 6 - Site Information



Section 7 - Transaction Information
Credit Card Processing Information



Gross Revenue: Cash+Credit+Debit+Check

ACH (eCheck) Processing Information


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