Name: Host Merchant Services - Credit Card Processing and Point of Sale for Small Business
Address: 250 Corporate Blvd L, Newark, DE, 19702
Telephone: +1 302-224-9837
Price range: $$

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Payment Processing Application

Please complete the form below. You will receive a confirmation email once you submit your application to accept credit cards with Greenlite. You may review the pricing and terms here.

Agents Application - Greenlite Yoga

1Contact Person Information

2Business Information

3Processing Info

4Owner Information

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GLID
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Referral Partner*
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Lead Source*
Contact Person Name*
First Last
Phone*
Email*

Legal Business Name*
Doing-Business-As Name (if applicable)
Legal Business Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Doing-Business-As Address (if applicable)
Street Address City State / Province / Region ZIP / Postal Code Country
Business Type*
Business Phone Number*
Age of Business*
Federal Tax ID (or SSN if sole proprietor)*

First Business Owners Info
Legally we must collect information for all owners with 25% or more ownership in the company.
Legal Name of Owner*
Date of Birth*
MM slash DD slash YYYY
Title*
Percentage of Ownership*
Email*
Phone*
Social Security Number*
Owner's Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are there additional owners to add?
- Yes
- No
Legally we must collect information for all owners with 25% or more ownership in the company.
Consent*
I agree to the terms and rates here
Second Owners Information
Legally we must collect information for all owners with 25% or more ownership in the company.
Legal Name of Owner
Date of Birth
MM slash DD slash YYYY
Title
Percentage of Ownership
Second Owner's Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment Processing Application

Agents Application - Greenlite Yoga

First Business Owners Info

Second Owners Information