Loop Payments
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Location Intake Form
Provide new location setup information for processing
Don't fill this out if you're human:
Submitter Email *
1
Business Information
Business Legal Name *
Business Legal Address *
City *
State *
ZIP *
Corporate Phone *
Federal Tax ID *
2
DBA / Location Information
DBA Name (if different)
Number of Terminals *
Shipping Speed *
Select...
Overnight AM
Standard Overnight
2/3 Day
Ground
Same as legal address
Location Physical Address *
City *
State *
ZIP *
Location Phone *
Primary Contact Name *
Primary Contact Phone *
Primary Contact Email *
Surcharge Amount
Surcharge Split
3
Additional Settings
Ship to same as location address
Ship to Address *
Store Hours *
Enterprise System *
Additional Email Addresses *
Add
Tipping Presets (preset prior to shipping) *
Enabled
Disabled
Integration Type (preset prior to shipping) *
Integrated
Stand-alone
4
Settlement Details
Banking Information
Bank Name *
Routing Number *
Account Number *
Bank Information For Surcharge
Bank Name
Routing Number
Account Number
Submit Intake Form