THE ALL IN ONE THAT’S DURABLE AND DEPENDABLE
NAVIGATION
SOCIAL
ADDRESS
(NY FINANCIAL DISTRICT)
1 LIBERTY PLAZA
165 BROADWAY 23RD FLOOR
NEW YORK, NY 10006
CONTACT
info@diademtechnologies.com
877-274-6652
COPYRIGHT 2021 DIADEM TECHNOLOGIES ALL RIGHTS RESERVED
APPLICATIONS
APPLICATIONS
LET’S GET STARTED
Welcome to our Application Submittal Portal. Please fill out each field and include all supporting documents
“We
lead
the way to opening new
opportunities
for
growth
”
- Darryl W. Elliott
.
MERCHANT PRE APPLICATION
Merchant Pre-Application
Please fill out the fields below.
Business Legal Name
*
DBA Name
*
Business Address
*
Business Phone
*
Business Fax:
Business Website URL
*
Business Email
Contact Name
Phone
Contact Email
Type Of Entity
*
Fed Tax ID
*
Month/ Year Started
*
Number Of Employees
*
Product/ Services Sold
*
Hours of Operation
*
Total Gross Annual Sales
*
Annual Credit/Debit Card Sales
*
Average ($) Credit/Debit Card Individual Sales Amount
*
Estimated Highest ($) Credit/Debit Card Individual Sales Amount
*
What percent is Credit/Debit Card
*
What percent is Web based / Gateway
*
What percent is Mail / Phone Order
*
Number of Inside Processing Terminals
*
Number of Outside Processing Terminals
*
Signer/ Owners Name
*
Signer Title
*
Signer Percent of Ownership
*
Signer Social Security Number
*
Signer Date of Birth
*
Signer Home Phone
*
Signer Home Address
*
Deposit Bank Name
*
Bank Routing Number
*
Bank Checking Account Number
*
Bank Phone Number
*
Due Diligence Documentation:
*
Voided check or Bank Letters
Driver License or Passport (for Each Signer/Principal
Business License or Articles of incorporation/ Organization or Operating Agreement
Documentation
POS System
*
Payment Terminal/ PIN Pad
*
Ingenico Lane 3000
Ingenico Lane 5000
Reveal Ingenico Move 5000
Ingenico iSelf Series
Ingenico iUC285
Online Gateway Integration
Sales Office
*
Rep Name
*
Rep Email
*
Rep Phone
*
Comments
*
Submit Form
(BWI AIRPORT)
780 ELKRIDGE LANDING RD
SUITE 210
LINTHICUM HEIGHTS MD 21090
NAVIGATION
SOCIAL
ADDRESS
(NY FINANCIAL DISTRICT)
1 LIBERTY PLAZA
165 BROADWAY 23RD FLOOR
NEW YORK, NY 10006
COPYRIGHT 2018 DIADEM TECHNOLOGIES ALL RIGHTS RESERVED
APPLICATIONS
APPLICATIONS
LET’S GET STARTED
Welcome to our Application Submittal
Portal. Please fill out each field and
include all supporting documents
“We
lead
the way
to opening new
opportunities
for
growth
”
- Darryl W. Elliott
CONTACT
INFO@DIADEMTECHNOLOGIES.COM
877-274-6652
Merchant Pre-Application
Please fill out the fields below.
Business Legal Name
*
DBA Name
*
Business Address
*
Business Phone
*
Business Fax:
Business Website URL
*
Business Email
Contact Name
Phone
Contact Email
Type Of Entity
*
Fed Tax ID
*
Month/ Year Started
*
Number Of Employees
*
Product/ Services Sold
*
Hours of Operation
*
Total Gross Annual Sales
*
Annual Credit/Debit Card Sales
*
Average ($) Credit/Debit Card Individual Sales Amount
*
Estimated Highest ($) Credit/Debit Card Individual Sales Amount
*
What percent is Credit/Debit Card
*
What percent is Web based / Gateway
*
What percent is Mail / Phone Order
*
Number of Inside Processing Terminals
*
Number of Outside Processing Terminals
*
Signer/ Owners Name
*
Signer Title
*
Signer Percent of Ownership
*
Signer Social Security Number
*
Signer Date of Birth
*
Signer Home Phone
*
Signer Home Address
*
Deposit Bank Name
*
Bank Routing Number
*
Bank Checking Account Number
*
Bank Phone Number
*
Due Diligence Documentation:
*
Voided check or Bank Letters
Driver License or Passport (for Each Signer/Principal
Business License or Articles of incorporation/ Organization or Operating Agreement
Documentation
POS System
*
Payment Terminal/ PIN Pad
*
Ingenico Lane 3000
Ingenico Lane 5000
Reveal Ingenico Move 5000
Ingenico iSelf Series
Ingenico iUC285
Online Gateway Integration
Sales Office
*
Rep Name
*
Rep Email
*
Rep Phone
*
Comments
*
Submit Form
MERCHANT PRE APPLICATION
(BWI AIRPORT)
780 ELKRIDGE LANDING RD
SUITE 210
LINTHICUM HEIGHTS MD 21090
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