payAWS - PreQ Form

			Merchant Pre-qualification Form:
	    This is not a working Form.

    	For demonstration purposes only.
    	
      This is not a legally binding agreement.
 This form gathers information for the purpose of 
      pre-qualifying
 an applicant
      for a PNC Merchant Account.
 Any and all informaton obtained

      is held in the strictest of confidence and security.

      We do not sell information to third parties or mailing lists.
    	
        		Business Information:
        	
        		Your Merchant ID:
        	
        		Legal Business Name *
        	
        		DBA Name *
        	
        		Business Address *
        	
        		Business: City *
        	
        		Business: State *
        	
        		Business: Zip *
        	
        		Business Phone:
        	
        		Business Fax:
        	
        		Business Tax ID:
        	
        		Business Inception Date:
        	
        		Number of Employees:
        	
        		Est. Annual Volume:
        	
        		Est. Average Sale:
        	
        		Email:
        	
        		Website:
        	
        		Personal Information:
        	
        		Applicants First Name:
        	
        		Applicants Last Name:
        	
        		Applicants Home Address:
        	
        		Applicant Home: City *
        	
        		Applicant Home: State Code *
        	
        		Applicant Home: Zip *
        	
        		Applicants Home Phone:
        	
        		Applicants Cell Phone:
        	
        		Applicants DOB:
        	
        		Applicants SS#:
        	
        		Applicants % of Ownership:
        	
        		Applicants Title:
        	
        		Additional Information:
        	
        		Business Type:
        	
        		Products Sold:
        	
        		Market Type:
        	
            Market Type?
          
        		Age of Business in Years:
        	
        		Industry Type Code:
        	
            Department of Labor SIC codes
          
  	  I declare under penalty of perjury under the laws of my State of residence that all
    information
 contained above is true and correct to be best of my knowledge.

Merchant Pre-qualification Form:

This is not a working Form. For demonstration purposes only.

This is not a legally binding agreement. This form gathers information for the purpose of pre-qualifying an applicant for a PNC Merchant Account. Any and all informaton obtained is held in the strictest of confidence and security. We do not sell information to third parties or mailing lists.

Business Information:

Personal Information:

Additional Information:

I declare under penalty of perjury under the laws of my State of residence that all information contained above is true and correct to be best of my knowledge.

This is not a working Form.
For demonstration purposes only.

This is not a legally binding agreement.
This form gathers information for the purpose of pre-qualifying
an applicant for a PNC Merchant Account.
Any and all informaton obtained
is held in the strictest of confidence and security.
We do not sell information to third parties or mailing lists.

I declare under penalty of perjury under the laws of my State of residence that all information
contained above is true and correct to be best of my knowledge.