5 Minute Application Helios Payments

Business Information

Legal Name*

*If sole proprieter enter your first and last name only, otherwise legal company name here

Type of Ownership*

DBA*

*(Doing Business As) This will appear on cardholder’s statement as the charge

Legal Address*

Premise Type

Length at Location*

Business Phone*

*Please enter numbers only no spaces or dashes

Tax ID/EIN*

*Please enter numbers only no spaces or dashes

Email Address*

Type of Business*

*What type of product or service do you offer?

Length of Ownership

*Please enter numbers only no spaces or dashes

Website Link

Personal Information

Full Name*

Address*

Time At Current Residence*

Social Security*

*Please enter numbers only no spaces or dashes

Drivers License*

Date of Birth*

Personal Phone*

*Please enter numbers only no spaces or dashes

Personal Email*

Bank Information

Bank Name*

Routing Number*

*Please enter numbers only no spaces or dashes

Account Number*

*Please enter numbers only no spaces or dashes

Documents

Articles of Incorporation*

EIN Filing (IRS Form SS-4)*

Voided Check*

Owner's Driver’s License*

Owner's Utility bill*

3 Months Business Bank Statements*

3 Months Personal Bank Statements*

Customer Support Agreement

Fulfillment Agreement

Credit Card Information

Currently Processing?*

Yes No

How Are You Taking Cards?*

In Person Swipe Online Over The Phone

Max. Monthly Sales (USD)*

*Please enter numbers only no commas, dollar sign or spaces

Average/Highest Tickets*

*Average Transaction Size in USD

*Highest Average Transaction Size in USD

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