Submit your GHL Clients using the form below

This form is for your GHL clients ONLY*

Agency Name *

Agency's Email *

Your Full Name *

Please provide your CLIENT'S information below.

First Name *

Last Name *

Owner's Address *

Owner's City *

Owner's State *

Owner's Zip Code *

Email *

Mobile Phone Number *

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CLIENT'S INFORMATION

Legal Business Name *

Type of Ownership *

Federal Tax ID # *

Address *

City *

State *

Postal code *

Incorporated State *

Business Phone Number *

Business Start Date *

Complete if different from LEGAL NAME

Merchant Business Name (Doing Business As)

DBA Address

DBA City

DBA State (Abbreviation Only)

DBA Zip Code

OWNERS/OFFICERS/PARTNERS

Social Security Number *

Date of birth *

Bankruptcies Within The Last Five Years? *

Yes

No

Upload Drivers License *

Upload Here

OWNERS/OFFICERS/PARTNERS

Do You Have 100% Equity Ownership? *

Yes

No

OWNERS/OFFICERS/PARTNERS

Owner One Equity Ownership %

Owner Two Equity Ownership %

OWNERS/OFFICERS/PARTNERS

Owner/Principal #2 Name

Owner/Principal #2 Residence Address

Owner/Principal #2 City

Owner/Principal #2 State

Owner/Principal #2 Zip Code *

Owner/Principal #2 Date of Birth

Owner Two: First Seven Digits of Social Security Number

Owner/Principal #2 EMAIL

Owner/Principal #2 Phone Number

General Business Info

Monthly Card Sales *

Average Ticket Transaction *

High Ticket Transaction *

Types of goods and services sold? *

Bank Name *

Deposit Routing Number *

Checking Account Number *

Voided Check *

Upload Voided Check Here

Office: 108 Jamestowne Court, Lexington SC 29072

Call (803) 626-1295

Email: [email protected]

Site: https://thegatlicgroup.com

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