Merchant Sign Up

    Person Completing This Application

    First Name*
    Last Name*
    Title (Position with company)*
    Email*
    Work Phone*
    Fax
    Mobile Phone
    How did you hear about Amerifirst?*
    Are you an owner?*
    YesNo

    Business Information

    Business Category*
    Business Legal Name (Merchant)*
    Federal Tax ID# or Social Security Number
    Federal Tax IDSocial Security Number
    Federal Tax ID#

    -
    Social Security Number

    - -
    All Names you are Doing Business As*
    In Business Since*
    Business Structure*
    Website/Business URL
    Annual Sales Revenue ($)*
    Annual Finance Volume ($)*
    Average Sale Price*
    Products Sold (hold ctrl on Windows or command on Mac to select multiple)*
    National or Enterprise Account Affiliation (if any)
    Physical Address
    Street Address*
    Address line 2
    City*
    State*
    Zip Code*
    Mailing Address
    Same as Physical Address
    Street Address
    Address line 2
    City
    State
    Zip Code

    Principal, Partner or Owner Information

    Please list all who have ownership interest of 25% or more

    Name
    First Name*
    Last Name*
    Email*
    Mobile Phone
    Birthdate*
    Owner Since
    Social Security #*
    - -

    Ownership Percentage*
    Home Address
    Street Address*
    Address line 2
    City*
    State*
    Zip Code*
    Add another Principal, Partner or Owner

    Additional Principal, Partner or Owner Information

    Name
    First Name
    Last Name
    Email
    Mobile Phone
    Birthdate
    Owner Since
    Social Security #
    - -
    Ownership Percentage
    Home Address
    Street Address
    Address line 2
    City
    State
    Zip Code
    Add another Principal, Partner or Owner

    Additional Principal, Partner or Owner Information

    Name
    First Name
    Last Name
    Email
    Mobile Phone
    Birthdate
    Owner Since
    Social Security #
    - -
    Ownership Percentage
    Home Address
    Street Address
    Address line 2
    City
    State
    Zip Code
    Add another Principal, Partner or Owner

    Additional Principal, Partner or Owner Information

    Name
    First Name
    Last Name
    Email
    Mobile Phone
    Birthdate
    Owner Since
    Social Security #
    - -
    Ownership Percentage
    Home Address
    Street Address
    Address line 2
    City
    State
    Zip Code

    By Clicking the check box below and submitting this application, you are certifying that you have read and agree to all Disclosures and the Merchant Financing Agreement.

    Sole Proprietorships and Partnerships: AmeriFirst may check and verify the credit history and secure credit reports for the Applicant(s) and any named or disclosed principals, owners or partners. The named or disclosed principals, owners or partners instruct and authorize any third party including but not limited to any consumer reporting agency, partner, subsidiary, and vendor to provide such report.

    Corporations: AmeriFirst may check and verify the credit history and secure credit report for the Applicant and any named or disclosed shareholders, stockholders, principals or owners. The named or disclosed shareholders, stockholders, principals or owners instruct and authorize any third party including but not limited to any consumer reporting agency, partner, subsidiary, and vendor to provide such report.

    I certify that the information submitted is true, accurate and complete. By submitting this Application, I certify that I have read and agree to the complete Disclosures and Merchant Financing Agreement.