{"id":10109,"date":"2021-07-13T08:56:11","date_gmt":"2021-07-13T08:56:11","guid":{"rendered":"http:\/\/demo.patelprocessing.com\/?page_id=10109"},"modified":"2026-03-23T09:09:59","modified_gmt":"2026-03-23T09:09:59","slug":"merchant-form","status":"publish","type":"page","link":"https:\/\/payment.patelprocessing.com\/ca\/merchant-form\/","title":{"rendered":"Merchant Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"10109\" class=\"elementor elementor-10109\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-87975d2 e-flex e-con-boxed e-con e-parent\" data-id=\"87975d2\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-be6f3c0 e-con-full e-flex e-con e-child\" data-id=\"be6f3c0\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9fb0814 elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"9fb0814\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Merchant Form\" aria-label=\"Merchant Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"10109\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9fb0814\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Merchant Form - Patel Processing\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"10109\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_aa07d9d elementor-col-100\">\n\t\t\t\t\t<h2>Business Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-business_name elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-business_name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tLegal Name Of Business\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[business_name]\" id=\"form-field-business_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Legal Name Of Business\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-dba_name elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dba_name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDBA Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[dba_name]\" id=\"form-field-dba_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"DBA Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_95d7be4 elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_95d7be4\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDate Of Business Established\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_95d7be4]\" id=\"form-field-field_95d7be4\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Date Of Business Established\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-taxyer_Id_number elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-taxyer_Id_number\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tTaxpayer identyfication number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[taxyer_Id_number]\" id=\"form-field-taxyer_Id_number\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Taxpayer identyfication number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_78cebea elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_78cebea\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBusiness Phone No\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_78cebea]\" id=\"form-field-field_78cebea\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Business Phone No\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-type_business elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-type_business\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tType Of Business\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[type_business]\" id=\"form-field-type_business\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Liquor Store\">Liquor Store<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grocery Store\">Grocery Store<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Convenience Store\">Convenience Store<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hotel\">Hotel<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Type Of Business\">Type Of Business<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-business_email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-business_email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBusiness Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[business_email]\" id=\"form-field-business_email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"yourbusiness@email \" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-business_website elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-business_website\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBusiness Website\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[business_website]\" id=\"form-field-business_website\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Business Website\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-physical_address elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-physical_address\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPhysical Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[physical_address]\" id=\"form-field-physical_address\" rows=\"2\" placeholder=\"Physical Address\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-unit elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-unit\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tUnit\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[unit]\" id=\"form-field-unit\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Unit\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-state elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-state\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[state]\" id=\"form-field-state\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"State\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-city elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-city\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[city]\" id=\"form-field-city\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-zip_code elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-zip_code\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tZip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[zip_code]\" id=\"form-field-zip_code\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Zip Code\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-billing_address elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-billing_address\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBilling Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[billing_address]\" id=\"form-field-billing_address\" rows=\"2\" placeholder=\"Billing Address\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-unit elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-unit\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tUnit\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[unit]\" id=\"form-field-unit\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Unit\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-state elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-state\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[state]\" id=\"form-field-state\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"State\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-city elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-city\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[city]\" id=\"form-field-city\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-zip_code elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-zip_code\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tZip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[zip_code]\" id=\"form-field-zip_code\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Zip Code\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_182d7c9 elementor-col-100\">\n\t\t\t\t\t<h2>Principal Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_db3b474 elementor-col-100\">\n\t\t\t\t\t<h3>List Name One Principal owner position help with company<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-last_name elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-last_name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[last_name]\" id=\"form-field-last_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-first_name elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-first_name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[first_name]\" id=\"form-field-first_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-middle_name elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-middle_name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tMiddle Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[middle_name]\" id=\"form-field-middle_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Middle Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-title elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-title\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tTitle\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[title]\" id=\"form-field-title\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Title\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-ownership_percent elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-ownership_percent\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tOwnership Percentage\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[ownership_percent]\" id=\"form-field-ownership_percent\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ownership Percentage\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-dob elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dob\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDate Of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[dob]\" id=\"form-field-dob\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Date Of Birth\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-social_security_num elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-social_security_num\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tSocial Security Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[social_security_num]\" id=\"form-field-social_security_num\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Social Security Number\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-homw_phone elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-homw_phone\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tHome Phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[homw_phone]\" id=\"form-field-homw_phone\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Home Phone\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-cell_phone elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-cell_phone\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCell Phone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[cell_phone]\" id=\"form-field-cell_phone\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Cell Phone Number\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-your_address elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-your_address\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tYour Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[your_address]\" id=\"form-field-your_address\" rows=\"2\" placeholder=\"Your Address\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-unit elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-unit\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tUnit\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[unit]\" id=\"form-field-unit\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Unit\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-state elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-state\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[state]\" id=\"form-field-state\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"State\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-city elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-city\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[city]\" id=\"form-field-city\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-zip_code elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-zip_code\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tZip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[zip_code]\" id=\"form-field-zip_code\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Zip Code\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-driving_lincen elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-driving_lincen\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDriving Lincense Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[driving_lincen]\" id=\"form-field-driving_lincen\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Driving Lincense Number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-lincens_expiredate elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-lincens_expiredate\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tLincense Expiry Date\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[lincens_expiredate]\" id=\"form-field-lincens_expiredate\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Lincese Expiry Date\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-owner_email elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-owner_email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tOwner Email Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[owner_email]\" id=\"form-field-owner_email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"ownerEmail@gmail.com\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_050ce0d elementor-col-100\">\n\t\t\t\t\t<h2>Attachment Required<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a4d6a9b elementor-col-30\">\n\t\t\t\t\tDriver Licenses\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-driver_license elementor-col-70 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-driver_license\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDriver Licenses\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[driver_license]\" id=\"form-field-driver_license\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_fe88a32 elementor-col-30\">\n\t\t\t\t\tVoided Check or Bank Letter\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-Check_BankLettter elementor-col-70 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Check_BankLettter\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tVoided Check or Bank Letter\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[Check_BankLettter]\" id=\"form-field-Check_BankLettter\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_368932d elementor-col-30\">\n\t\t\t\t\tOther Document\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-Other_doc elementor-col-70\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Other_doc\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tOther Documents\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[Other_doc]\" id=\"form-field-Other_doc\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-FNS_number elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-FNS_number\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tFNS Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[FNS_number]\" id=\"form-field-FNS_number\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"FNS Number If you process EBT \/ food Stamp\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7fa6af7 elementor-col-100\">\n\t\t\t\t\t<h2>Banking Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f749d7f elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f749d7f\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tName Of the Bank\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f749d7f]\" id=\"form-field-field_f749d7f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name of the Bank Finance Institute\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8629e04 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8629e04\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBank Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8629e04]\" id=\"form-field-field_8629e04\" rows=\"1\" placeholder=\"Address\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-business_account_num elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-business_account_num\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBusiness Checking Account Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[business_account_num]\" id=\"form-field-business_account_num\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Business Checking Account Number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-business_routing_num elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-business_routing_num\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBusiness Checking Routing Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[business_routing_num]\" id=\"form-field-business_routing_num\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Business Checking Routing Number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_d6fc517 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d6fc517\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAcceptance\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_d6fc517]\" id=\"form-field-field_d6fc517\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\">\n\t\t\t\t<label for=\"form-field-field_d6fc517\">I Accept the <a href=\"https:\/\/www.firstdata.com\/downloads\/pdf\/206637-First-Data_PL_MerchantGuidelines.pdf\" target=\"_blank\" rel=\"noopener\">Terms and Conditions<\/a><\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_1da4041 elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_1da4041\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6Lfhk2YsAAAAAFCu0KCbPSZxJYD7z-ya8fl_xn70\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-10109","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/pages\/10109","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/comments?post=10109"}],"version-history":[{"count":25,"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/pages\/10109\/revisions"}],"predecessor-version":[{"id":16131,"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/pages\/10109\/revisions\/16131"}],"wp:attachment":[{"href":"https:\/\/payment.patelprocessing.com\/ca\/wp-json\/wp\/v2\/media?parent=10109"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}