Sps New Merchant Questionnaire Form

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SPS New Merchant Questionnaire
Owing to more stringent Audit & Regulatory Requirements being enforced by various entities of our Federal and State Government’s
Banking authorities and NACHA itself, we are now required to provide more detailed information relating to the business activities of
our prospective Customers. While the heightened level of this enforcement is ‘new’, the concept itself is not, and falls well within the
‘Know Your Customer’ obligations of all participants in the banking system, including SPS as a third party sender of electronic
transactions.
1)
Legal Business Name:
________________________________________________________________________________________________________
2) DBA Name: __________________________________________________________________________________________________________________
3) Physical Address: ____________________________________________________________________________________________________________
__________________________________________________________________________________________________________
4) Mailing Address: ____________________________________________________________________________________________________________
__________________________________________________________________________________________________________
5)
Email Address: _______________________________________________________________________________________________________________
6) Phone #: _______________________________ 7) Federal Tax ID #: _______________________________________________________
8)
Owner/Officer Name (1) :
__________________________________________________________________ % Ownership: _________________
Position: _________________________________________________ SSN: _____________________________ DOB: ___________________________
Phone #: _________________________________________________ Email: ________________________________________________________________________________
Residence: _______________________________________________ City: _____________________________ St/ZIP: _________________________
Owner/Officer Name (2) :___________________________________________________________________ % Ownership: _________________
Position: _________________________________________________ SSN: _____________________________ DOB: ___________________________
Phone #: _________________________________________________ Email: ____________________________________________________________
Residence: _______________________________________________ City: ______________________________ St/ZIP: ________________________
If more than 2 Owners, please attach a listing of Owner names including information requested above and submit respective
DLs. If a Corp, please attach current Officer Listing.
9) Length of time current owner(s) has/have owned this business: _____________________________________________________________
10) Is this business owned by a larger entity?
Yes
No
If yes, please explain: __________________________________________________________________________________
Please attach a sheet with the owner info of that entity as outlined in the Owner/Officer section above.
11) Is there any foreign (non-U.S.) ownership in this Company?
Yes
No
If yes, please explain: _________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
12) Please state/describe the nature and purpose of your Company’s business activity and provide a detailed description of the
Products or Services that your Company sells: _______________________________________________________________________________
______________________________________________________________________________________________________________________________
13) Does the nature of your business require any regulatory licenses?
Yes
No
(and provide such licenses to our
office): ________________________________________________________________
If yes, please explain
______________________________________________________________________________________________________________________________
14) Does your business do any lending or extension of credit?
Yes
No
If yes, please explain: ________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
15) If you are a Third Party Collection Agency, what type of collections work are you performing? (ie. Collecting NSF
Checks/ACH or collecting on bad debt): ______________________________________________________________________________________

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