Heartland Merchant Account Form
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Company Name *
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Phone *
Currently Processing Credit Cards
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List of Needed Information
> DBA Name, Address and Phone Number
> Ownership Setup (LLC, Sole Proprietor, etc.)
> Tax ID
> Website will need Terms & Conditions, Privacy Policy, Refund Policy & Card Logos
> Sample Contracts; Purchase, Terms, Lease/Payments
> Individual Contact Info (Name, SSN, % Ownership)
> Voided Check
> 1-3 Months Credit Card Processing Statements (If available)

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Contact Information
Contact Information
Steven Butala
P: 480-467-0359
E: support@landacademy.com
W: www.buwit.com
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