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Pre-Application Form – Business Services
Requested Services
Full Name:
*
Date of Birth:
*
Email address
*
Home Address:
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SSN (9 digits):
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Driver’s License Number or passport
*
State / Expiration Date:
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Select
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Rate Your Personal Credit
Excellent (720+)
Good (680–719)
Fair (640–679)
Poor (below 640)
Unsure / I don't know
BUSUNESS INFORMATION
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DBA (Doing Business As):
Phone Number:
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Email Address:
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Business Address:
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City / State / ZIP:
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Business Start Date
*
Percentage of Ownership in the Business
*
Website:
Tax ID (9 digits):
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Products or Services Sold:
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Average Ticket Amount ($):
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Method of Sales Used in the Business
*
Please select at least one option.
In-person (storefront or office)
Online / eCommerce
Phone sales
Mobile / On-site services
Subscription / Recurring billing
Other: ___________
Estimated Monthly Sales Volume ($):
*
Message
E-Signature (Full Name):
*
Date
*
Terms and Conditions
*
Please select at least one option.
📄 Terms and Conditions – Brand&Mind Merchant Solutions By Brand&Mind Software and Marketing LLC By submitting this form, you acknowledge and agree to the following terms and conditions: Accuracy of Information The client guarantees that all information provided in this form is true, complete, and accurate. Approval Process Submitting this form does not constitute automatic acceptance. Brand&Mind Software and Marketing LLC reserves the right to verify the information and approve or deny the request based on internal and regulatory criteria. Authorization for Contact The client authorizes Brand&Mind Software and Marketing LLC to contact them via email, phone, or text message to follow up on the request and provide information related to its services. Use of Personal Data The data collected will be used exclusively for evaluation, contact, and the provision of the requested service. Brand&Mind Software and Marketing LLC is committed to protecting and safeguarding personal information in accordance with applicable data privacy regulations. Services and Responsibility Payment processing, merchant services, and POS systems will be provided in accordance with current commercial policies. The client understands that service activation is subject to bank approval and financial regulations. Costs and Fees The client acknowledges that costs, fees, or commissions will be communicated clearly and transparently, and that signing or accepting a specific contract will be required before starting the commercial relationship. Limitation of Liability Brand&Mind Software and Marketing LLC shall not be liable for losses arising from incorrect information provided by the client or from failure to comply with the agreed terms. Acceptance By checking the corresponding box and submitting this form, the client confirms that they have read, understood, and accepted these terms and conditions.
File Upload
*
Please select at least one option.
EIN Letter from the IRS
Government-issued Photo ID
Voided Business Check
Last 3 Bank Statements
Upload Here
*
Service Request
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