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Liquor Max Application

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Submitted on Aug 15, 2026 at 9:14 AM

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Liquor Max Application

Legal Name of Business^*

Address^*

Search country…

Form.custom Fields.dba Name Andor Address Same As Legal

Yes

DBA Name^*

DBA Address^*

Search country…

Email Address^*

Website Address

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Month

Year

Chargeback Notifications Email^*

Chargebacks Address

Legal

DBA

Statements Address

Legal

DBA

Contact First & Last Name^*

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Position in company (owner, admin etc.)^*

Form.custom Fields.any Prior Business Bankruptcies

Yes

Form.custom Fields.any Prior Personal Bankruptcies

Yes

Ownership and IRS W-9 Info - Content

Business Name (Exact business name submitted on your last income tax return)^*

Name of Contact for Secure IRS Related Information^*

Position in company (owner, admin etc.) for Secure IRS Related Information^*

Email of Contact for Secure IRS Related Information^*

Form.custom Fields.receive 1099K Statements Via Secure Email

Yes

Form.custom Fields.tax Exempt

Yes

Form.custom Fields.type Of Tax Id

EIN

SSN

ITIN

Tax Identification # (TIN)^*

Description of Products or Services Sold^*

Owner/Officer Info - Content

Name^*

Job Title^*

Form.custom Fields.us Citizenus Resident

Yes

Social Security #^*

Month

Year

% Ownership^*

Country Of Residence^*

Residential Address^*

Search country…

Form.custom Fields.add Another Owners Info

Yes

Name^*

Title^*

Form.custom Fields.us Citizenus Resident 2

Yes

Social Security #^*

Month

Year

% Ownership^*

Country Of Residence^*

Residential Address^*

Search country…

Form.custom Fields.add Another Owners Info 2

Yes

Name^*

Title^*

Form.custom Fields.us Citizenus Resident 3

Yes

Social Security #^*

Month

Year

% Ownership^*

Country Of Residence^*

Residential Address^*

Search country…

Processing Info - Content

Form.custom Fields.has Merchant Ever Accepted Credit Cards Before

Yes

Processor Name^*

Number of Locations^*

Form.custom Fields.does Merchant Bill Their Customers Prior To Goods Being Ship

Yes

Form.custom Fields.how Many Days Prior

0-2

3-30

31-60

61-90

Over 90

What is your Return and Refund Policy? (Please be Specific)^*

Form.custom Fields.is This A Seasonal Business

Yes

What type of credit card processing are we doing for you?

Card-Swiped Transactions %^*

Manually Keyed (Card Present with Imprint) %^*

Manually Keyed (Card Not Present and/or Mail Order/Telephone Order) %^*

eCommerce (Card Not Present)^*

Business to Business Sales % (Value must be 0 - 100%)^*

Form.custom Fields.does Merchant Use A Third Party To Fulfill Products Or Servi

Yes

Projected Volume - Content

Average Transaction (Ticket) Amount $^*

Total Monthly Sales $^*

Form.custom Fields.does Annual Amex Volume Exceed

Yes

Form.custom Fields.would Merchant Like To Receive Amex Marketing Materials

Yes

Banking Info - Content

Bank Name^*

Routing #^*

Account #^*

Type of Account^*

Upload Liquor License (required)^*

Upload Driver License (required)^*

Upload any existing merchant processing statements

Upload any additional files

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