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First Name*

Last Name*

Email*

DOB*

Company Type*(What will be indicated on your tax returns?)

Phone Number*

Business Legal Name*(Make sure this matches EXACTLY as in your IRS forms)

Business DBA(Your store front name or business name)

Social Security Number

Bank Routing Number

Bank Account Number

Owner's Home Address

Business Website

Business Address*

Address Line 2

City

State/Province/Region

Zip/Postal Code

Country

Business TAx ID or EIN*

Approx month and year business registered

Job Title*

Business Type

Do You Have a Refund Policy*

What do you sale or which service do you provide?Short description of what do you sell. Ex. Rugs, Food, Cut Hair