paragonsolutions.com
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Submitted URL: https://citizensbankreferral.paragonsolutions.com/
Effective URL: https://paragonsolutions.com/form.php?DCREFID=18600
Submission: On July 23 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://paragonsolutions.com/form.php?DCREFID=18600
Submission: On July 23 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
Name: BankForm — POST salesforcesendmail.php
<form id="form_298211" name="BankForm" class="appnitro" onsubmit="return ok()" method="post" action="salesforcesendmail.php" enctype="multipart/form-data">
<div class="form_description">
<h2>Citizens Bank - TX Referral Form</h2>
<input name="BANK" type="hidden" value="Citizens Bank - TX">
<input name="DCREFID" type="hidden" value="18600">
<input name="BANKEMAIL" id="BANKEMAIL" type="hidden" value=", tbusby@citizensbanktx.com">
<input name="AGENTEMAIL" id="AGENTEMAIL" type="hidden" value="brittney.schmiedbauer@paragonsolutions.com">
</div>
<ul>
<li id="li_2">
<label class="description" for="element_2">Referred by: </label>
<div>
<input id="element_2" name="element_2" class="element text medium" type="text" maxlength="255" value="">
<font color="red">*</font>
</div>
</li>
<li id="">
<label class="description" for="refContact">Referred By Contact Phone: </label>
<span>
<input id="refContact_1" name="refContact_1" class="element text phone" size="3" maxlength="3" value="" type="text"> - <label for="refContact_1">(###)</label>
</span>
<span>
<input id="refContact_2" name="refContact_2" class="element text phone" size="3" maxlength="3" value="" type="text"> - <label for="refContact_2">###</label>
</span>
<span>
<input id="refContact_3" name="refContact_3" class="element text phone" size="4" maxlength="4" value="" type="text">
<label for="refContact_3">####</label>
</span>
<span>
<input id="refContact_4" name="refContact_4" class="element text phone" size="5" maxlength="5" value="" type="text">
<label for="refContact_4">Extension</label>
</span>
</li>
<li id="li_4">
<label class="description" for="element_4">Date </label>
<span>
<input id="element_4_1" name="element_4_1" class="element text" size="2" maxlength="2" value="" type="text"> / <label for="element_4_1">MM</label>
</span>
<span>
<input id="element_4_2" name="element_4_2" class="element text" size="2" maxlength="2" value="" type="text"> / <label for="element_4_2">DD</label>
</span>
<span>
<input id="element_4_3" name="element_4_3" class="element text" size="4" maxlength="4" value="" type="text">
<label for="element_4_3">YYYY</label>
</span>
<span id="calendar_4">
<img id="cal_img_4" class="datepicker" src="calendar.gif" alt="Pick a date.">
<font color="red">*</font>
</span>
<script type="text/javascript">
Calendar.setup({
inputField: "element_4_3",
baseField: "element_4",
displayArea: "calendar_4",
button: "cal_img_4",
ifFormat: "%B %e, %Y",
onSelect: selectDate
});
</script>
</li>
<li id="li_3">
<label class="description" for="element_3">Branch: </label>
<div>
<!-- <input id="element_3" name="element_3" class="element text medium" type="text" maxlength="255" value=""/> -->
<select class="element select medium" id="element_3" name="element_3">
<option value="" selected="selected"></option>branch: Bryan-College Station<option value="Bryan-College Station">Bryan-College Station</option>branch: Carthage<option value="Carthage">Carthage</option>branch: Center<option value="Center">
Center</option>branch: Humble<option value="Humble">Humble</option>branch: Kilgore<option value="Kilgore">Kilgore</option>branch: Kilgore In-Store<option value="Kilgore In-Store">Kilgore In-Store</option>branch: Kountze<option
value="Kountze">Kountze</option>branch: Sour Lake<option value="Sour Lake">Sour Lake</option>branch: The Woodlands<option value="The Woodlands">The Woodlands</option>branch: Yorktown<option value="Yorktown">Yorktown</option>
</select>
<font color="red">*</font>
</div>
</li>
<li id="li_5">
<label class="description" for="element_5">I can be reached at: </label>
<span>
<input id="element_5_1" name="element_5_1" class="element text" size="3" maxlength="3" value="" type="text"> - <label for="element_5_1">(###)</label>
</span>
<span>
<input id="element_5_2" name="element_5_2" class="element text" size="3" maxlength="3" value="" type="text"> - <label for="element_5_2">###</label>
</span>
<span>
<input id="element_5_3" name="element_5_3" class="element text" size="4" maxlength="4" value="" type="text">
<label for="element_5_3">####</label>
</span>
</li>
<li id="li_6">
<label class="description" for="element_6">Email </label>
<div>
<input id="element_6" name="element_6" class="element text medium" type="text" maxlength="255" value="">
<font color="red">*</font>
</div>
</li> <!-- <li id="li_1" >
<label class="description" for="element_1">I have a customer interested in: </label>
<span>
<input id="element_1_14" name="element_1_14" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_14"><b>PayGov</b><img src="./images/new_icon.jpg" border=0> </label>
<input id="element_1_1" name="element_1_1" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_1">Credit/Debit Card Processing</label>
<input id="element_1_2" name="element_1_2" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_2">Multi-Check / Instant Credit</label>
<input id="element_1_3" name="element_1_3" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_3">Electronic Benefits Transfer (Food Stamps)</label>
<input id="element_1_4" name="element_1_4" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_4">Gift & Loyalty Cards</label>
<input id="element_1_5" name="element_1_5" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_5">Cash Advance Program</label>
<input id="element_1_6" name="element_1_6" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_6">Clover POS</label>
<input id="element_1_8" name="element_1_8" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_8">Virtual Terminal</label>
<input id="element_1_9" name="element_1_9" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_9">Check Guarantee</label>
<input id="element_1_10" name="element_1_10" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_10">ACH Services</label>
<input id="element_1_11" name="element_1_11" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_11">Wireless Processing</label>
<input id="element_1_12" name="element_1_12" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_12">Mobile Payments</label>
<input id="element_1_13" name="element_1_13" class="element checkbox" type="checkbox" value="1" />
<label class="choice" for="element_1_13">Other</label>
</span>
</li> -->
<li id="li_20">
<label class="description" for="element_20">Monthly Credit Card Volume: </label>
<div>
<select class="element select medium" id="element_20" name="element_20">
<option value="" selected="selected"></option>
<option value="0-20000">$0-$20,000</option>
<option value="20000-40000">$20,000-$40,000</option>
<option value="40000-60000">$40,000-$60,000</option>
<option value="60000 and up">$60,000 and up</option>
</select>
<font color="red">*</font>
</div>
</li>
<li id="li_7">
<label class="description" for="">Business Owner's Name:</label>
<div>
<span class="name">First Name:</span><input id="firstname" name="firstname" class="element text medium" type="text" maxlength="255" value="">
<font color="red">*</font>
</div>
<div>
<span class="name">Middle Name:</span><input id="middlename" name="middlename" class="element text medium" type="text" maxlength="255" value="">
</div>
<div>
<span class="name">Last Name:</span><input id="lastname" name="lastname" class="element text medium" type="text" maxlength="255" value="">
<font color="red">*</font>
</div>
<div>
<span class="name" style="width:81px;">Email Address:</span>
<input id="ContactEmail" name="ContactEmail" class="element text medium" type="text" maxlength="255" value="">
</div>
</li>
<li id="li_8">
<label class="description" for="element_8">Business Phone: </label>
<span>
<input id="element_8_1" name="element_8_1" class="element text" size="3" maxlength="3" value="" type="text"> - <label for="element_8_1">(###)</label>
</span>
<span>
<input id="element_8_2" name="element_8_2" class="element text" size="3" maxlength="3" value="" type="text"> - <label for="element_8_2">###</label>
</span>
<span>
<input id="element_8_3" name="element_8_3" class="element text" size="4" maxlength="4" value="" type="text">
<label for="element_8_3">####</label>
</span>
<span>
<input id="element_8_4" name="element_8_4" class="element text phone" size="5" maxlength="5" value="" type="text">
<label for="element_8_4">Extension</label>
</span>
<font color="red">*</font>
</li>
<li id="li_9">
<label class="description" for="element_9">Home: </label>
<span>
<input id="element_9_1" name="element_9_1" class="element text" size="3" maxlength="3" value="" type="text"> - <label for="element_9_1">(###)</label>
</span>
<span>
<input id="element_9_2" name="element_9_2" class="element text" size="3" maxlength="3" value="" type="text"> - <label for="element_9_2">###</label>
</span>
<span>
<input id="element_9_3" name="element_9_3" class="element text" size="4" maxlength="4" value="" type="text">
<label for="element_9_3">####</label>
</span>
</li>
<li id="li_10">
<label class="description" for="element_10">Name of Business (DBA): </label>
<div>
<input id="element_10" name="element_10" class="element text medium" type="text" maxlength="255" value="">
<font color="red">*</font>
</div>
</li>
<li id="li_11">
<label class="description" for="element_11">Address: </label>
<div>
<input id="element_11_1" name="element_11_1" class="element text large" value="" type="text">
<label for="element_11_1">Street Address</label>
</div>
<div>
<input id="element_11_2" name="element_11_2" class="element text large" value="" type="text">
<label for="element_11_2">Address Line 2</label>
</div>
<div class="left">
<input id="element_11_3" name="element_11_3" class="element text medium" value="" type="text">
<label for="element_11_3">City</label>
</div>
<div class="right">
<input id="element_11_4" name="element_11_4" class="element text medium" maxlength="2" value="" type="text">
<label for="element_11_4">State</label>
</div>
<div class="left">
<input id="element_11_5" name="element_11_5" class="element text medium" maxlength="10" value="" type="text">
<label for="element_11_5">Postal / Zip Code</label>
</div>
<div class="right">
<select class="element select medium" id="element_11_6" name="element_11_6">
<option value="" selected="selected"></option>
<option value="United States">United States</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Costa Rica">Costa Rica</option>
<option value="C么te d'Ivoire">C么te d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="North Korea">North Korea</option>
<option value="South Korea">South Korea</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia and Montenegro">Serbia and Montenegro</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
<label for="element_11_6">Country</label>
</div>
</li>
<li id="li_12">
<label class="description" for="element_12">Type of Business: </label>
<div>
<select class="element select medium" id="element_12" name="element_12">
<option value="" selected="selected"></option>
<option value="Individual/Sole Proprietorship">Individual/Sole Proprietorship</option>
<option value="Limited Liability Company">Limited Liability Company</option>
<option value="Partnership">Partnership</option>
<option value="Tax Exempt Organization (501C)">Tax Exempt Organization (501C)</option>
<option value="Government (Federal, State, Local)">Government (Federal, State, Local)</option>
<option value="International Organization">International Organization</option>
<option value="Medical or Legal Corporation">Medical or Legal Corporation</option>
<option value="Association/Estate/Trust">Association/Estate/Trust</option>
<option value="Public Corp.">Public Corp.</option>
<option value="Private Corp.">Private Corp.</option>
</select>
<font color="red">*</font>
</div>
</li>
<li id="li_13">
<label class="description" for="element_13">Notes: </label>
<div>
<textarea id="element_13" name="element_13" class="element textarea medium"></textarea>
</div>
</li>
<li id="li_14">
<label class="description" for="element_14">Upload Document: <i>Attach Merchant Statements</i></label>
<div>
<input id="element_14" name="uploaded_file1" class="element text medium" type="file" maxlength="255" value="">
</div>
<div>
<input id="element_15" name="uploaded_file2" class="element text medium" type="file" maxlength="255" value="">
</div>
<div>
<input id="element_16" name="uploaded_file3" class="element text medium" type="file" maxlength="255" value="">
</div>
</li>
<div class="g-recaptcha" data-sitekey="6LfKxLMZAAAAABZ18_6qcm7PB4yHbBrUNZflATGb">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-6m57p2cr3n43" frameborder="0" scrolling="no"
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</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<li class="buttons">
<input type="hidden" name="form_id" value="298211">
<input id="saveForm" class="button_text" type="submit" name="submit" value="Submit">
</li>
</ul>
</form>Text Content
Citizens Bank - TX Welcome to the Paragon Payment Solutions Referral Page Please enable javascript in your browser. REFERRAL FORM CITIZENS BANK - TX REFERRAL FORM * Referred by: * * Referred By Contact Phone: - (###) - ### #### Extension * Date / MM / DD YYYY * * Branch: branch: Bryan-College StationBryan-College Stationbranch: CarthageCarthagebranch: CenterCenterbranch: HumbleHumblebranch: KilgoreKilgorebranch: Kilgore In-StoreKilgore In-Storebranch: KountzeKountzebranch: Sour LakeSour Lakebranch: The WoodlandsThe Woodlandsbranch: YorktownYorktown * * I can be reached at: - (###) - ### #### * Email * * Monthly Credit Card Volume: $0-$20,000 $20,000-$40,000 $40,000-$60,000 $60,000 and up * * Business Owner's Name: First Name: * Middle Name: Last Name: * Email Address: * Business Phone: - (###) - ### #### Extension * * Home: - (###) - ### #### * Name of Business (DBA): * * Address: Street Address Address Line 2 City State Postal / Zip Code United States Afghanistan Albania Algeria Andorra Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica C么te d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Country * Type of Business: Individual/Sole Proprietorship Limited Liability Company Partnership Tax Exempt Organization (501C) Government (Federal, State, Local) International Organization Medical or Legal Corporation Association/Estate/Trust Public Corp. Private Corp. * * Notes: * Upload Document: Attach Merchant Statements * Powered by Paragon Payment Solutions