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Business Details
Legal Business Name
*
Legal Business Name *
Doing Business As
*
Doing Business As *
Address Line 1
*
Address Line 1 *
Address Line 2
Address Line 2
City
*
City *
State
State
Zip
*
Zip *
Entity Structure
Entity Structure
State of Incorporation
State of Incorporation
EIN
*
EIN *
Years in Business
*
Years in Business *
Category
Category
Website
*
Website *
Annual Sales
Annual Sales
Average Order Value
*
Average Order Value *
Bank Account Number
*
Bank Account Number *
Bank Routing Number
*
Bank Routing Number *
Owner 1 Details
First Name
*
First Name *
Last Name
*
Last Name *
Last 4 Social Security Number
*
Last 4 Social Security Number *
Date of Birth (MM/DD/YYYY)
*
Date of Birth (MM/DD/YYYY) *
Email
*
Email *
Phone
*
Phone *
Residency Address Line 1
*
Residency Address Line 1 *
Residency Address Line 2
Residency Address Line 2
Residency Address City
*
Residency Address City *
Residency Address State
Residency Address State
Residency Address Zip
*
Residency Address Zip *
Percent Ownership
*
Percent Ownership *
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Sezzle (or its Installment Services Provider) may conduct ongoing diligence of the Merchant (including its owners and principal officers) to comply with its policies and procedures and applicable law and may obtain information from third party sources on the Merchant, its owners, and principals officers in connection therewith. By submitting this form, Merchant agrees that any information relating to Merchant provided to Sezzle (which may include personal, non-public information) may be shared with third parties, including the Installment Service Provider and its affiliates.