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. .~Merchant A U T H D R I T Y
CREDIT CARD PROCESSING QUESTIONNAIRE

06/28/2024
DATE (mm/dd/yy)_____________

FULKSHAULING WEARS CORP

CORPORATE NAME (INC/CORP/LLC) _______________________________________________________

FULKSHAULING WEARS
DBA NAME (SAME AS ON CC RECEIPT) ____________________________________________________

847 W MAPLE ST
BUSINESS ADDRESS ____________________________________________________________________

FLORA
CITY ________________________________________ IL
STATE ___________________ 62839
ZIP_____________ -

TEL 6186990909 TONYF6125@GMAIL.COM

_________________ FAX ________________ EMAIL _______________________________________

FULKSHAULING.ICU
WEBSITE _________________________________ CEO
TYPE OF OWNERSHIP _________________________

351460760
TAX ID __________________ 03/2020
DATE BUSINESS STARTED (mm/yy) _______________ IL
STATE _________

OWNER NAME TONY FULK

______________________________________________ 351460760
SS# _______________________

841 W MAPLE ST
HOME ADDRESS ____________________________________________ 6186990909
TEL _______________________

FLORA
CITY ________________________________________ STATE ___________________
IL 62839
ZIP_____________

DATE OF BIRTH (mm/dd/yy 02/14/1952

_____________

1345242514741
ACCOUNT (DDA) # _______________________ROUTING 041215663
(ABA) # _______________________________

DEBIT (PINPAD) YES? Y

GROSS MONTHLY SALE (CREDIT/DEBIT) ___________

50,000 YEARLY TOTAL (MC/VISA) 600k

1000
AVERAGE PURCHASE TICKET _______________ 2000
HIGHEST PURCHASE TICKET __________________

CLOTHES, BAGS, SHOES

PRODUCTS OR SERVICES SOLD ________________________________ 0
TELEPHONE ORDER %_____

Please, provide a voided copy or a check bearing your company’s name