application_kwickpos_online_ordering

Online Order Application

Owner's Name (老板名字) *

Please fill out this field.

Cell Phone Number (手机) *

Please fill out this field in correct format.

Email (邮箱) *

Doing Business As (招牌名字) *

Please fill out this field.

Business Phone Number (电话) *

Please fill out this field in correct format.

Address (公司地址) *

Please fill out this field.

City (城市) *

Please fill out this field.

State(州) *

Please fill out this field.

Zip Code (邮政编码) *

Please fill out this field in correct format.

Menu Upload*:

Service and Plan Choice

What kind of online service do you need?

Please fill out this field.

Plan Choice *

Promo Special / $1.00 Per Order (Customer Pays)

Free Plan / $1.50 Per Order (Customer Pays)

$159/Month (Unlimited Orders)

5% Per Order

Payment Setup

Payment Option *

In Store + Online Payment

Online Payment Only

In-store Payment Only

Enroll in Cash Discount?
Yes, customers will pay a surcharge fee for online credit card transactions
No, customers will pay NO additional surcharge for online credit card transactions

Please fill out this field in correct format.

Required Document: Owner's ID (证件) *

Please fill out this field in correct format.

Legal Name of Business (公司名字) *

Please fill out this field in correct format.

Social Security Number (社安号码) *

Format should be number xxx-xx-xxxx.

Federal Tax ID # (联邦报税号码) *

Format should be numbers xx-xxxxxxx.

Required Document: IRS Document (联邦税号文件)

Please fill out this field in correct format.

ACH Payment

Authorizes KwickPOS, ZBS POS CORP to charge the agreeable monthly commission from the following bank account.

Account No.: *

Must be number between 4 to 17 digit.

Routing No.: *

Please fill out this field in correct format 9 digit numeric.

Required Document: Voided Check (支票) *

Please fill out this field in correct format.

Others

Other information you would like us to know

Note

Agent Name

Agent Email

Please fill out this field in correct format.

Merchant Acceptance Each person signing below agrees to the terms and conditions stated in the front and back of this agreement and certifies that all information providedin the application is true, correct and complete. Client acknowledges and agrees that we, our Affiliates and our third party subcontractors and/or agents may use automatictelephone dialing systems to contact Client at the telephone number(s) Client has provided in this Merchant Processing Application and Agreement and/or may leave a detailedvoice message in the event that Client is unable to be reached, even if the number provided is a cellular or wireless number or if Client has previously registered on a Do NotCall list or requested not to be contacted by Client for solicitation purposes.