Nrs CC application

Email*

Customer Type*
Existing POS CustomerNew POS CustomerNRS PAY only

Business Information
DBA*

Legal Name*

DBA Full Address*

DBA Phone Number*

Legal full address*

TIN*

Customer Type*
C CorporationLLCPartnershipS CorporationSole Proprietor
Length of ownership*
Less than a yearMore than a year
Is your store a Smoke Shop/CBD?*
YesNo
Owner Information
Full Name*

Email*

Cell Phone*

Date Of Birth*

SSN*

Home Full Address*

Current home address is less than 2 years?*
YesNo
Additional Owner*
YesNo
Bank Account Information
Bank Name*

Account Name*

Routing Number*

Account Number*

Your total monthly credit card charges (approximately)*

Yearly store total sales (approximately)*

EBT Number

Void Check*