Merchant Information

External Merchant Application

Complete the following application to be approved for participation by the university.

Required field =

Business/Store Information

Business/Store Name

Character Limit: 256

Street/P.O. Box

Character Limit: 256

City

Character Limit: 256

Store State

Zip

Character Limit: 20

Business/Store Website

Character Limit: 256

Business/Store Slogan

Character Limit: 256

Phone

Format: XXX-XXX-XXXX

Alcohol Sales

Number of years in business

Character Limit: 256

Number of years at current location

Character Limit: 256

Corporate Owner Information

Last Name

Character Limit: 128

First Name

Character Limit: 128

Street/P.O. Box

Character Limit: 256

City

Character Limit: 128

State

Zip

Character Limit: 20

Phone

Format: XXX-XXX-XXXX

Reimbursement Information

Checks will be made payable to Corporation Name or Individual, but not both.

Corporation Name

Character Limit: 256

Last Name

Character Limit: 128

First Name

Character Limit: 128

Street/P.O. Box

Character Limit: 128

City

Character Limit: 128

State

Zip

Character Limit: 20

Phone

Format: XXX-XXX-XXXX

Tax Information

Federal Tax ID #

Character Limit: 128

Corporate Entity

Character Limit: 128

State Incorporated

Name and Title of Person Signing Agreement

Last Name

Character Limit: 128

First Name

Character Limit: 128

Title

Character Limit: 128

Sales Reports

Would you like to receive sales reports via email?

Email addresses to receive sales reports

What category best fits your business?

Restaurant Type

Do you deliver?