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First Name
Last Name
Mobile Phone
Email
Organization Name
License Number
Tax Identification Number
Description of Organization
Street Address
City
State
Zip Code
Products you are interested in
Money Transfer
EZ Mart
Both
Do you currently offer money transfer service at any of your locations?
Yes
No
Type of Identification
Passport
Driver's License
Government ID
Upload your identification and business documents below.
ID Number
The above referenced Organization / Individual (Organization / Individual) Desires to enter into a business relationship with EZ Transfer, LLC (Collectively EZT) and hereby provides the following information for the purpose of the prequalification to offer one or more of the EZT services. Organization / Individual understands that the acceptance of the information does not warrant or obligate EZT to enter into a business relationship with Organization / Individual.
I hereby grants permission and authorization to EZT and its affiliates as well as trade references, Dun & Bradstreet, banks, and consumer credit services and to state and federal government agencies without regard to whether they are listed herein, to verify, receive, exchange and obtain business or personal credit and other information of Organization / Individual of any of its principals as part of this prequalification process or at any time thereafter in connection with the ongoing application evaluation process by EZT, The Organization / Individual further agrees that EZT nor anyone who has furnished EZT information concerning the Organization / Individual or its principals shall be responsible for any losses or damages resulting from said verification, receipt, exchange or obtaining business and/or personal credit information.
Signature
Date
I have read and agree to the EZ Transfer Privacy Statement.
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