linked2pay - Payment Solutions

Registration - Step 1 of 5

When filling out this form and throughout the registration process all required fields will be marked with an asterisk (*). The forms will not let you proceed if any required field is left empty.

The "referred by" field enables us to associate your registration with the sales organization or business partner that introduced you to us.

Legal Business Name:

DBA:

Physical Address 1: (PO Box Not Allowed)

Address 2:

City:

State:

Zip Code:

Years at Location:

Months at Location:

Mailing Address is same as Business Address

Mailing Address 1:

Mailing Address 2:

Mailing City:

Mailing State:

Mailing Zip Code:

Phone:

Fax:

Website URL:

Referred By:

Years in Business:

Corporate Structure:

Business License:

Business License Issue Date:

Sales Tax ID Number:

Sales Tax ID Number Issuing State:

Sales Tax ID Number Issuing Date:

Federal Tax ID:

Company Description:

Merchant Category Code

Promo Code:

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Basic Information