Page 30 - Pitch Book Test

Business Information Signer Information
q Legal Name q Full Name
q Location Address q Home Address
q Billing Address q Home Phone #

q Main Phone # q SS#
q Federal Tax ID q Driver's License
q Email Address

q Contact Processing Statements
q 3 Months Processing
Banking Information
q Voided Check PCI Compliant YES or NO

q Copy of Certificate
Business Financials
q Profit & Loss Virtual Terminal
q Balance Sheet q Pay Now

q Recurring
Terminal Type / Programming q Batch Upload
q Make______________ q ACH Addendum
q Model______________ q Gateway __________

q Dial or IP q USB Swiper - Qty
q EMV / Contactless / NFC q Printer______________
q PIN Pad ____________ q Auto Close _________

q Dial 8 or 9
q Auto Close _______ Software
q Tips q Name_____________
q Servers __________ q Version ____________

q Passwords
q Invoice Prompt Mobile Application
q Quick Serve q Phone Make / Model
q EBT / Cash / Food Stamps / Both q Tablet Make / Model

q EBT Acct #______________ q Swiper ___________