New Merchant Enrollment

Onboarding Form

Business Information:

Name of Business *

Federal Tax ID / EIN *

Organization Type *

Doing Business As (DBA)

Date of Incorporation (Secretary of State) *

Publicly Traded? *

Yes

Address *

Business Address

City

State

Country

Postal Code

Business Phone *

Business Fax (If not applicable type: N/A)

Number of Locations *

Business Website *

Merchant Email *

Merchant Type *

Do you want to enroll into the Guaranteed Approval Program? *

Yes

Estimated Annual Finance Volume (e.g., $200,000) *

Estimated Annual Sales (e.g., $1,000,000) *

Average Cost of Product/Service (e.g., $10,000) *

Has the company ever declared bankruptcy? *

Yes

If Yes, When?

Principal Information

This information must be filled correctly or enrollment cannot be processed. If you have questions on the following please reach out and inquire before submitting inaccurate information.

Principal 1 Social Security Number (SSN) *

Are there additional owners? *

Yes

Company Contact for Financing

The Financing Contact

Contact Name *

Contact Title *

Contact Phone *

Contact Email *

Portal Email

Banking Information

Depository Bank Name *

Depository Bank Location *

Routing / Transit Number *

Account Number *

Upload voided check or bank-issued ACH form (must show account & routing number ownership) *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Signature *

Clear

About Us

EzFi provides fast consumer financing, business funding, and lower-cost credit card processing to help businesses grow revenue and improve cash flow.

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