C Mart Technologies Application
Business Name
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Business Address
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Business Phone Number
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Business Email Address
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Corporate Legal Name
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Corporate Address if different than above
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Type of Business
Company Website
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Year Established
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Place of Business
Is Place of Business Leased or Owned
Building Type
Square Footage of Building
Do you currently accept credit cards for payments?
Monthly Visa/MC/DSC/AMX $ Volume
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Average Transaction $ Amount
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Highest Potential Transaction $ Amount
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Primary Contact Name
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Primary Contact Title
Primary Contact % of Ownership
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Tax ID / EIN (or SSN if not Incorporated)
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Primary Contact Date of Birth
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DD
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YYYY
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