ESA & MPA-G-Tech Payments

ESA & MPA

Complete this form and authorize G-tech Payments, a Global Technologies & Distribution, LLC card services company permission to open, host and maintain a merchant account(s) to facilitate payments for on your behalf as requested and intended; to use the information you provide, attachments uploaded as well as your electronic signature. Please complete the below Merchant Processing Application

I agree to provide my cell phone number below for SMS notification, call backs notes, automated text notifications as well as security checks and occasional marketing.

Please create a 4 digit security PIN for caller verification, ie tech or service calls.

First Name

Email (to login with)

I swear that the information provided is true and most accurate to the best of my abillity.

Front of ID

Back of ID

I am the person stated above, shown on the IDptovided to G-Tech Payments. Also, the signature is my signatre and will match the signatre on my state ID

Business Phone Number

Business Address

Legal Business or Corporate Name (The name you file with)

DBA Name (Doing business as)

Business Start Date (unsure? take your best guess)

Federal Tax ID # (Sole Prop? Please enter your SSN)

I agree to the terms & conditions as well as give permission to G-Tech Payments to place my signature in the appropriate fields required to complete my order or solution tailored to my business needs.

Draw your signature the same way as you signed on your ID. They must match.

Completed by or with

My Self (Merchant)

An authorized G-Tech Representitive

Other Details

Merchant statements don't provide every piece of information we like to have in order to set you up best so please answer these questions to the best of your ability.