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Please fill in the applicable fields to the best of your ability. Please attached your ID(s) and VOID Cheque, or deposit form (PAD). You will be contacted if we have any questions. This information will be used to complete and send you an Application for E-signature. If you have any questions, you can contact your Advisor or you can email us at info@peloton-technologies.com or call Toll Free: 1-800-723-8108.
Who sent you?*—Please choose an option—BertCatColeCraigDannyDebraGordIsabelJennJohnLiamMarcMartinNicole R.Nikki M.RachelRickSamSumeyyahTasha
Legal Name of Business*
Corporate/Business Address
Street Address*
City* Province*—Please choose an option—ABBCMBNBNLNTNSNUONPEQCSKYT
Postal Code*
Shipping Address
Shipping address- same as Business Address?*YesNo
DBA Name*
Type of Business*—Please choose an option—Sole ProprietorshipNon-ProfitPublic CorporationPrivate CorporationGovernment
Date Started*
Business Phone*
Business Email*
Business Website
If more owners are required to make up 51% ownership, please fill out details for additional owners on a separate form.
Owner Name*
Personal Phone*
Personal (Home) Address*
ID Required (Government Issued Picture ID)*
Title*
Personal Email*
% of Ownership (need 51% minimum from either one partner, or as many as is required to make 51%)*
Add Additional Owner
Secondary Owner
Owner Name
Personal Phone
Personal (Home) Address
ID Required (Government Issued Picture ID)
Title
Personal Email
% of Ownership (need 51% minimum from either one partner, or as many as is required to make 51%)
Business Location*—Please choose an option—HomeApartmentMallDoor to DoorFlea MarketIsolatedOfficeShopping AreaOther
If Other, please specify
Currency*CADUSD
Average Credit Transaction Size*
What is the highest sale price (of goods and/or services) that you have run or expect to run as a Credit Card Transaction?*
Approximate square footage of your business
Number of Employees
Is your business Seasonal?*YesNo
If Yes, what months are you in operation?
On average, how many times per year would you run your highest sale price?*
A copy of a Void Cheque or Bank Deposit Form is required. A Void Cheque must have the Business Name (Legal or DBA) printed on it. If using a Bank Deposit Form, the form needs to show the Bank letterhead (Name, Logo, Address).
Route (Bank) #* Transit #* Account #*
Upload a Void Cheque or Bank Deposit Form*
Please note, this form does not designate a completed application, but is used to fill out our e-Applications which will be sent to you via your email provided for e-Signatures. If you require a paper application to be sent to you either by mail, or as an attachment, instead of an e-Application, please let us know by emailing us at info@peloton-technologies.com or calling Toll Free: 1-800-723-8108
Any information you provide on this form is not shared or sold to any third party.
