Merchant Application

Please complete this brief application to begin your merchant approval process and to receive more information on all of our loan programs. Within two business days we will contact you with the status of your application to become an authorized member of our network.

Person Completing This Application

Name
First Name*
Last Name*
Title (Position with company)*
Email*
Work Phone*
Fax
Mobile Phone
How did you hear about Amerifirst?*
Are you an owner?*
YesNo
Other

Business Information

Business Category*
Business Legal Name (Merchant)*
Federal Tax ID# or Social Security Number
Federal Tax IDSocial Security Number
Federal Tax ID#
-
Social Security Number
- -
All Names you are Doing Business As*
In Business Since*
Business Structure*
Website/Business URL
Annual Sales Revenue ($)*
Annual Finance Volume ($)*
Average Sale Price*
Products Sold (hold ctrl on Windows or command on Mac to select multiple)*
Physical Address
Street Address*
Address line 2
City*
State*
Zip Code*
Mailing Address
Same as Physical Address
Street Address
Address line 2
City
State
Zip Code

Principal, Partner or Owner Information

Please list all who have ownership interest of 25% or more

Name
First Name*
Last Name*
Email*
Mobile Phone
Birthdate*
Owner Since
Social Security #*
- -

Ownership Percentage*
Home Address
Street Address*
Address line 2
City*
State*
Zip Code*
Add another Principal, Partner or Owner

Additional Principal, Partner or Owner Information

Name
First Name
Last Name
Email
Mobile Phone
Birthdate
Owner Since
Social Security #
- -
Ownership Percentage
Home Address
Street Address
Address line 2
City
State
Zip Code
Add another Principal, Partner or Owner

Additional Principal, Partner or Owner Information

Name
First Name
Last Name
Email
Mobile Phone
Birthdate
Owner Since
Social Security #
- -
Ownership Percentage
Home Address
Street Address
Address line 2
City
State
Zip Code
Add another Principal, Partner or Owner

Additional Principal, Partner or Owner Information

Name
First Name
Last Name
Email
Mobile Phone
Birthdate
Owner Since
Social Security #
- -
Ownership Percentage
Home Address
Street Address
Address line 2
City
State
Zip Code

By Clicking the check box below and submitting this application, you are certifying that you have read and agree to all Disclosures and the Merchant Financing Agreement.

Sole Proprietorships and Partnerships: AmeriFirst may check and verify the credit history and secure credit reports for the Applicant(s) and any named or disclosed principals, owners or partners. The named or disclosed principals, owners or partners instruct and authorize any third party including but not limited to any consumer reporting agency, partner, subsidiary, and vendor to provide such report.

Corporations: AmeriFirst may check and verify the credit history and secure credit report for the Applicant and any named or disclosed shareholders, stockholders, principals or owners. The named or disclosed shareholders, stockholders, principals or owners instruct and authorize any third party including but not limited to any consumer reporting agency, partner, subsidiary, and vendor to provide such report.

I certify that the information submitted is true, accurate and complete. By submitting this Application, I certify that I have read and agree to the complete Disclosures and Merchant Financing Agreement.