Please fill form out below...

The information you submit below will be used to complete your payment processing application, which will be sent to you for e-signature.

Your business is considered “high-risk” in the payment processing industry, but SparkUpBiz Services

specializes in these markets and has streamlined the process to make it as simple as possible.

If you have questions, email [email protected].

Include “Clinic Protocols,” your company name, and your full name so we can assist you quickly.

Websites MUST have:

Age Pop Up to access
Each item must have full ingredient list
Prescription items require a login with verification system
For underwriting purposes, please provide a login and password. This will need to be maintained throughout your account for regulatory reviews.

Please fill the form out below.

We will be sending you your application within the

next 24 hours for esignature.

All documents must be in pdf format. If you do not have a scanner, we suggest you go to your phone's app store and download Adobe Scan (it's free). You can use it to scan single and multi-page documents.

Please label the documents with "YOUR COMPANY NAME" followed by the title of document (i.e. XYZ Company EIN Letter or XYZ Company Jane Doe Drivers License).

Main Contact is:

First Name *

Last Name *

Phone *

Email *

Corporate/Legal Name *

Corporate Street Address *

Corporate State *

Corporate City *

Corporate Zip *

Merchant Name/DBA *

DBA/Location Address *

DBA/Location City *

DBA/Location State *

DBA/Location Zip *

Choose Mailing Address *

Years in Business *

Federal Tax ID# *

# of Locations *

Owner #1 Name *

Owner #1 Title *

Owner #1 % of Ownership *

Owner #1 Home Street Address *

Owner #1 Home City *

Owner #1 Home State *

Owner #1 Home Zip *

Owner #1 MOBILE Phone *

Owner #1 Social Security # *

Owner #1 DOB *

Owner #1 Email Address *

Owner #1 Driver's License # *

Owner #1 Driver's License State *

Owner #2 Name

Owner #2 Title

Owner #2 % of Ownership

Owner #2 Home Street Address

Owner #2 Home City

Owner #2 Home State

Owner #2 Home Zip

Owner #2 MOBILE Phone

Owner #2 Social Security

Owner #2 DOB

Owner #2 Email Address

Owner #2 Driver's License State

Owner #2 Driver's License #

Owner #3 Name

Owner #3 Title

Owner #3 % of Ownership

Owner #3 Home Street Address

Owner #3 Home City

Owner #3 Home State

Owner #3 Home Zip

Owner #3 MOBILE Phone

Owner #3 Social Security

Owner #3 DOB

Owner #3 Email Address

Owner #3 Driver's License #

Owner #3 Driver's License State

Owner #4 Name

Owner #4 Title

Owner #4 % of Ownership

Owner #4 Home Street Address

Owner #4 Home City

Owner #4 Home State

Owner #4 Home Zip

Owner #4 MOBILE Phone

Owner #4 Social Security

Owner #4 DOB

Owner #4 Email Address

Owner #4 Driver's License #

Owner #4 Driver's License State

Average Ticket? *

Maximum Ticket *

Ownership Type *

Bank Name *

Full Bank Address: *

Bank Routing # *

Bank Routing # (Confirm) *

Bank Account # *

Bank Account # (confirm) *

Describe refund policy: *

Merchant: *

Landlord's Name & Full Address *

How will this product be advertised or promoted? *

List the name(s) and address(es) of the vendor(s) from which supplies are purchased: *

Who performs product/service fulfillment? If different from vendor, please provide Vendor Name, address, and phone in full: *

If you have an area to signin on the website, for regulatory purposes and checks, please provide a signon ID for the bank to keep on file:

Please provide the password

Owner #1 Colored Copy of the Driver's License *

PDF

Owner #1 Selfie Holding Colored Copy of the Driver's License Up Close *

PDF

Owner #2 Colored Copy of the Driver's License

PDF

Owner #2 Selfie Holding Colored Copy of the Driver's License Up Close

PDF

Owner #3 Colored Copy of the Driver's License

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Owner #3 Selfie Holding Colored Copy of the Driver's License Up Close

PDF

Owner #4 Colored Copy of the Driver's License

PDF

Owner #4 Selfie Holding Colored Copy of the Driver's License Up Close

PDF

3 Months Full Business Bank Statements *

PDF

3 Months Full Payment Processing Statements

PDF

Voided Business Check *

PDF

State Business Registration Paperwork *

PDF

EIN Letter *

PDF

Operating Agreement/Partnership Papers (if Applicable) *

PDF

Pictures of product inventory (on the shelves and in boxes, etc) *

PDF

If using 3rd party fulfillment house, copy of the agreement

PDF

By checking “I agree,” you consent to receive marketing & communications from SparkUpBiz Services via text message, email, and telephone (including automated and pre-recorded calls). Message and data rates may apply. You may opt out at any time by replying “STOP” to texts, clicking “unsubscribe” in emails, or contacting us at [phone/email]. For details, see our Privacy Policy and Terms of Service.

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For more information:

[email protected]