Heartland Merchant Account Form
Email address *
Company Name *
Your answer
Name *
Your answer
Phone *
Your answer
Currently Processing Credit Cards
List of Needed Information
> DBA Name, Address and Phone Number
> Ownership Setup (LLC, Sole Proprietor, etc.)
> Tax ID
> Website will need Terms & Conditions, Privacy Policy, Refund Policy & Card Logos
> Sample Contracts; Purchase, Terms, Lease/Payments
> Individual Contact Info (Name, SSN, % Ownership)
> Voided Check
> 1-3 Months Credit Card Processing Statements (If available)
Your answer
Contact Information
Contact Information
Steven Butala
P: 480-467-0359
E: support@landacademy.com
W: www.buwit.com
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Global Payments. Report Abuse - Terms of Service