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456 Montgomery Street, STE 200, San Francisco, CA, 94104, US


Tell Us What Solution You're Interested In

Which Plan Are You Interested In?

Tell Us A Little About Yourself

Tell Us About Your Business

How Would You Like To Pay For The Hardware?

I hereby authorize VividPayments, LLC to charge the above account for the hardware selected in Section 1 of this application.

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Which Address Would You Like The Hardware Shipped Too?

Shipping Address

Tell Us More About Your Business

Corporate Address

Is Your Physical Location Address The SAME As Your Corporate Address?

Physical Location Address

Indicate if Classified as:

Tell Us About Your Sales

Do you currently accept Visa/MC/Discover® Network?

How Do You Plan On Accepting Payments? (Use Percentages)

Tell Us More About Your Sales

Who owns product?

Are consumers required to provide a deposit?

Tell Us About Your Ownership

Residential Address

Are there any other Owners that own 25% or more?

Upload Driver's License and Voided Check