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Nextera Payments - Business Profile Form
Business Legal Name with Applicable DBA*
Business Type*
- LLC
- Partnership
- Corporation
- Sole Proprietor
Federal Employer Identification Number (EIN#)*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Ownership Information
Primary Applicant Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Social Security Number (SSN)*

Your SSN is only used for verification of identity.
Date of Birth (DOB)*
Secondary Applicant Name (If Applicable)
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Social Security Number (SSN)

Your SSN is only used for verification of identity.
Date of Birth (DOB)
Existing Business Annual Revenue

Please provide your Annual Revenue amount for the prior year for Existing Businesses
New Business Projected Revenue

Please provide the projected Annual Revenue for your new Business
Voided Check*
Drop files here or

Max. file size: 256 MB, Max. files: 2.
PLEASE UPLOAD A CLEAR IMAGE OF A VOIDED CHECK FOR BANK DEPOSITS - YOUR ACCOUNT WILL NOT BE CREATED WITHOUT THIS
Comments
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Nextera Payments - Business Profile Form