Merchant Forms

1 Business Contact Information
5 Step 5

Please fill in the form below and email your completed application to the email listed above. By signing below, you certify that all information and documents submitted in connection with this application are true, correct, and accurate. Incomplete applications will not be processed.

Business Contact Information
Legal Entitypick one!
Was Business Purchased from a Previous Owner?pick one!
Do you have any outstanding loans or advances?
Do you own the business property?
Are you current with rent/mortgage?
Are you a
Are you a

(If additional Owners/Principals, please attach that information to this application.)

Authorizations: By signing below, each of the above listed business and business owners (individually and collectively, “you”) authorize Take Payments Group Ltd, LLC (“TPG”) and its affiliates, successors, assigns and designees (“Recipients”) to obtain consumer, personal and business reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize TPG to transmit this Application, along with any information obtained in connection with this Application, excluding consumer credit reports, to any or all of the Recipients. Further, you give TPG, or an agent acting on its behalf, permission to call and/or send you text/SMS messages at the phone number(s) provided above, including your wireless number, using an automated telephone dialing system or other similar system for marketing purposes.

Payments to Independent Sales Organizations (“ISOs”): Some transactions funded by TPG are originated by third-party ISOs who act as brokers. TPG compensates ISOs based on the amount of the advance a referral merchant obtains from TPG and, in some cases, the rate paid by the merchant.

Notice: If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial within 30 days of TPG receiving your request for the statement. To obtain the statement, please contact TPG at the above address or phone number within 30 days from the date you are notified of the credit decision. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, colour, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, 600 Pennsylvania Ave. NW, Washington, DC 20580.

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