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Business Information (Required)
Legal Business Name
State Tax ID Number
Store Phone Number
Business Address
Street 2
City
State
Zip
Email
Owner's Information (Required)
First/Last Name Printed
Owner's Home Address
Owner's City
Owner's State
Owner's Zip
Owner's Cell Number
ACH Information
Name of Bank
Bank Account Number
Bank Routing Number
Please attach a photo or scan of your Driver's License
Please attach a photo or scan of a valid State Business License
Please attach a photo or scan of a voided Business Check
Please sign after confirming the above information is correct.
All the above information is correct, and I consent to the submission of this application to H2O Wireless
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