Member Application and Service Agreement Sample Contracts

This Member Application and Service Agreement (“Application”) form may be completed using your computer. In order to use the fillable features, please note the following:‌

Member Application and Service Agreement • November 24th, 2017 • Georgia

• Contract Type
  Member Application and Service Agreement
• Filed
  November 24th, 2017
• Jurisdiction
  Georgia

Check all that apply: PPD CCD WEB TEL BOC ARC POP RCK Check 21 Check Guarantee ISO/Agent Name: COMPANY INFO BUSINESS DATA Legal Name: DBA: Contact Person: Phone Number: Fax Number: Website URL: E‐Mail: Business Address: City: State: Zip: Business Start Date: Business Type: Goods / Services: Average Ticket: High Ticket: Annual Check Volume: Total Sales Volume: Business Tax ID: Corporate Structure:Non‐Profit Sole Proprietorship Private Corp LLC Public Corp Partnership OWNER INFORMATION (for beneficial owners of 25% or more) OWNER INFORMATION (for beneficial owners of 25% or more) Full Name: Percentage Ownership: Home Address: City: State: Zip: Title: Social Security #: Driver’s License #: State: Phone Number: Fax Number: Full Name: Percentage Ownership: Home Address: City: State: Zip: Title: Social Security #: Driver’s License #: State: Phone Number: Fax Number: OWNER INFORMATION (for beneficial owners of 25% or more) OWNER INFORMATION (for beneficial owners of 25% or more) Full Name: