Secure Biz Hub - Merchant Application

Merchant Application

1741 Newnan Crossing Blvd E, Newnan, GA, 30265 | (888) 921-1052 | info@securebizhub.com

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Section 1: Business Information

Business Details

Legal Business Name (as registered)

Please provide a legal business name.

DBA / Store Name

Ownership Type

Sole Proprietorship Partnership LLC C-Corp S-Corp Non-Profit

EIN

Date Established

Business Address

Time at this address?

Mailing Address (if different)

Business Phone

Website URL

NAICS / MCC (if known)

Processing Profile

Monthly Card Volume ($)

Average Ticket ($)

High Ticket ($)

% Card Present

Combined percentage total cannot exceed 100%.

% eCommerce

Combined percentage total cannot exceed 100%.

% MOTO (Mail/Telephone Order)

Combined percentage total cannot exceed 100%.

Primary Contact

Name

Title

Mobile

Section 2: Ownership & KYC

Principal / Beneficial Owners

Section 3: Processing Details

Describe Products/Services (including any risk factors)

Refund Policy

Fulfillment Time (days)

Prior Processing?

Yes No

Prior Processor Name

Please provide the prior processor name.

Chargeback Ratio (last 6 mo) %

Please provide the chargeback ratio.

Section 4: Banking, Authorizations & Signatures

Banking Information

Depository Bank Name

Account Type

Routing (ABA)

Account (DDA)

Authorizations & Signature

ACH Authorization: I/we authorize Secure Biz Hub and its designated PSP/MSP/acquiring bank partners to initiate ACH credits and debits to/from the account above.

Credit & Background Authorization: By signing below, each undersigned owner/officer authorizes Secure Biz Hub and its PSP/MSP/acquiring bank partners to obtain credit reports and other background information for underwriting and review purposes.

Personal Guarantee (Optional): I agree to personally guarantee obligations arising under the merchant agreement.

Signature (Type Full Name)

Print Name

Title

Date

Section 5: Supporting Documents

Upload Supporting Documents

Required Documents:

Driver's License
Articles of Organization
Void Check/Bank Letter
3 Months of Bank Statements/Last Month Processing Statement
EIN Document

Optional Documents: SSN Card, Agreement, 3 Month Processing Statements, Other

Document Type

Other Description (if Other selected)

Drag & drop files here, or click to select files

Section 1: Business Information

Section 2: Ownership & KYC

Section 3: Processing Details

Section 4: Banking, Authorizations & Signatures

Section 5: Supporting Documents

Uploaded Documents:

Required Documents Status:

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