application_kwickpos_online_ordering

Service and Plan Choice

Type of Business *

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Account Type

What kind of online service do you need?

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API

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

Promo Special / Dual Pricing (Free)

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

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Other Comment

Business Information

Legal Name of Business (公司名字) *

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Doing Business As (招牌名字) *

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Address (公司地址) *

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City (城市) *

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State (州) *

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Zip Code (邮政编码) *

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Business Phone Number (电话) *

Please fill out this field in correct format.

Federal Tax ID # (联邦报税号码) *

Format should be numbers xx-xxxxxxx.

Agent Name

Agent Email *

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Legal Type *

Sole Proprietor or Single-Member LLC

Partnership

Corporation

LLC

Principle Information

Owner's Name (老板姓名) *

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Email (邮箱) *

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Cell Phone Number (手机) *

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Home Address (住家地址) *

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Home City (城市) *

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Home State (州) *

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Home Zip Code (邮政编号) *

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Social Security Number (社安) *

Format should be number xxx-xx-xxxx.

Account No.: *

Must be number between 4 to 17 digit.

Routing No.: *

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

Date of Birth (出生日期) * Please select right date of birth.

Driver License Number (驾照) *

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State Issued (驾照所在州) *

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Attachment Required

Voided Check (支票) *

Please fill out this field in correct format.

Owner's ID (证件) *

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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 provided in 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 automatic telephone 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 detailed voice 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 Not Call list or requested not to be contacted by Client for solicitation purposes.