Vendor Signup – LiQuidCash

Merchant Quick Application

Referring Agent Name:

Company Name:

DBA or Trade Name:

Contact First Name:

Middle Initial:

Last Name:

Industry Type:

Date of Birth:

EIN (Tax ID) or SSI:

Street Address:

City:

State:

Country:

Postal Code Zip:

Company Phone Number:

Cell Phone Number:

Email Address:

Company Website:

Are you interested in Selling on iYap Mall?

Do you need any type of financing?

What is your current sales volume?

What is your average item price?

Describe the type of products / services you offer?