[Vivid] Mangomint Application

Poynt Terminal Options

Purchase

Payment Plan

Lease

Already Owned

Business Information

Legal Business Name

DBA Name:

Type Of Ownership

Date Business Started

Federal Tax ID #:

Product / Service Sold

Website

Bank Name

Bank Account #

Bank Routing #

Sales Information

Average Transaction Amount

High-End Transaction Amount

Total Monthly Card Volume

What is your Return, Refund, or Cancellation Policy?

Ownership Information

Full Name

Title

Ownership %

Email Address

Phone Number

Social Security Number

Date of Birth

Residence Address (Street Address, City, State, ZIP)