SynqPay

1

Merchant Profile

DBA (Doing Business As)*

Entity Type*

Contact First Name*

Contact Last Name*

Contact Mobile*

Email*

Business Phone

Fax

Business Address*

City*

State*

ZIP*

Federal Tax ID / EIN / SSN*

Business Start Date*

Current Ownership Length

Website

Mailing Address (if different)

2

Principal Information (Owner / Partner / Officer)

Full Name*

Initials*

Title*

Date of Birth*

Social Security Number*

Phone Number*

Driver License Number*

Driver License State*

DL Expiration*

Home Address*

City*

State*

ZIP*

3

Financial Information

Bank Name*

Account Name*

Account Type*

Routing Number*

Account Number*

4

Additional Information

Merchant Type*

Average Sale Amount ($)*

High Ticket ($)*

Average Monthly Sales ($)*

Do You Take Tips?*

FNS Number (EBT)

Business Close Time*

5

Attachments

Owner's Driver License*Click to uploadJPG, PNG, or PDF

Voided Check / Signed Bank Letter*

Front side only - Check or Bank Letter must have preprinted DBA name with address, routing & account numbers

Click to uploadJPG, PNG, or PDF

Retail / Business LicenseClick to uploadJPG, PNG, or PDF

SS-4 Form

If requested - EIN verification

Click to uploadJPG, PNG, or PDF

Last 3 Credit Card StatementsClick to uploadJPG, PNG, or PDF

501(c)(3) Form / 1023 EZ Application

If requested - For non-profit organizations

Click to uploadJPG, PNG, or PDF

Last 3 Bank StatementsClick to uploadJPG, PNG, or PDF

Devices & Special Requests

📱 Note: In the next step, when E-Signing your forms with a phone, rotate phone horizontal to see all info.

Special Requests

Special Instructions for E-Sign

I Understand — I certify that the information provided in this application is true and accurate to the best of my knowledge. I authorize Synq Payment Systems, LLC to verify all information, conduct credit checks, and contact references as part of the merchant underwriting process.

Legal Disclaimer: Synq Payment Systems, LLC ("Synq") selectively underwrites merchant accounts based on business type, risk assessment, and transaction volume. All savings estimates, rebate amounts, and cost-savings claims shown on this site are illustrative only and may vary depending on your individual transaction mix, average ticket size, and prevailing network fees. Services are provided subject to Synq's Terms of Service and Privacy Policy. Synq expressly disclaims liability for any losses arising from transaction processing—including chargebacks, network interruptions, or fraud—and does not guarantee uninterrupted service or specific savings. Card acceptance and payment terms are further governed by card network rules and issuing-bank policies. For full licensing details and regulatory disclosures, please see our Legal & Compliance pages.

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Merchant Profile

Principal Information (Owner / Partner / Officer)

Financial Information

Additional Information

Attachments

Devices & Special Requests