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Business Information (Required)
Legal Business Name
Doing Business As ("None" if none)
Federal Tax ID Number
Business Address
City
State
Zip
Store Phone Number
Email
Owner's Information (Required)
First/Last Name Printed
Owner's Date of Birth (00/00/0000)
Owner's Cell Number
Owner's Home Address
Owner's City
Owner's State
Owner's Zip
Please attach a photo or scan of your Driver's 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 T-Cetra (Vidapay)
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