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1550 Larimer Street

Denver, Colorado 80202

(818) 850-1034

Sales & Customer Support

Complete the Merchant Pre-qualification Form in its Entirety

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OWNER | CONTROLLING MANAGING PARTNER (must have at least 75% controlling interest)

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ADDITIONAL OWNER (Controlling managing partner with 25% or more controlling interest)

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ACH AUTHORIZATION | BANK DEPOSIT DETAILS. *Identify the bank where funds shall settle for deposit. Must be a valid checking account.

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UNDERWRITING PROFILE
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REQUESTED PROCESSING PARAMETERS

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TERMS & CONDITIONS OF ACCEPTANCE
This Merchant Account Pre-Qualification form is not a binding contract for service. Information provided in this form allows the ISO and Merchant Services Providers to pre-vet for suitability the applicant. Furthermore, all information provided in this form is considered private and confidential in nature. Under no circumstances will your data be sold to or shared with any outside party that has no direct involvement in the provisioning of service.

SERVICE DISCLAIMER & LIABILITY WAIVER
Under no circumstances does submission of an application for a merchant account guarantee approval of service. The ISO/sales agent shall will not be held financially responsible nor liable for any costs, fees, business expenses or any losses if an application for a merchant account is declined.

INDEMNIFICATION & WAIVER OF RISK & LIABILITY
Merchant/Applicant agrees to indemnify, defend, and hold harmless KJ Proweb, its officers, directors, agents, employees, and suppliers from and against any lawsuit, claim, liability, loss, penalty or other expense (including attorneys’ fees and cost of defense) they may suffer or incur as a result of a bank or MSPs inability to delivery merchant processing services as described in a Enrollment Application for Service. If you, the merchant/applicant do not agree with nor accept this Indemnification and Waiver of Liability in its entirety, do not apply for service.

After submitting this form, our preferred payment processor will email you a DocuSign Agreement. Sign and return the Service Agreement.

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