Vivid

sales@hellovivid.com

1 Harbor Drive, Suite 300, Sausalito, CA, 94965, US

800-496-0437

Tell Us A Little About Yourself

Full Name:

Email Address:

Phone Number:

Tell Us About Your Business

Legal Business Name:

Doing Business As (DBA):

Type of Ownership:

Date Business Started:

Product / Service Sold:

Federal Tax ID Number:

Website (If applicable):

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

Yes

Bank Name:

Bank Account # (DDA):

Bank Routing # (ABA):

Tell Us About Your Sales

Does your business currently accept credit cards?

Yes

Estimated Average Ticket Amount

Estimated High-End Ticket Amount

Estimated Monthly Card Volume

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

% Store Front/ In-Person

% Phone Order (Keyed)

% E-Commerce

What is your return, cancellation, or refund policy?

Tell Us About Your Ownership

Name

Title

Date of Birth

Social Security Number

Ownership %

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

Yes

Name

Ownership %

Date of Birth

Social Security Number

Upload Driver's License and Voided Check

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Tell Us What Solution You're Interested In

What Solution Would You Like?

Please Specify Product:

Which Address Would You Like The Hardware Shipped Too?

Legal

Physical

Other

Not Applicable

Additional Questions/Comments?