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2Checkout.com, Inc. 1785 O’Brien Road
Columbus Ohio 43228
FAX: 1-614-921-2451
Please complete the accompanying form in it's entirety, with your signature on the final page. In order this form to be considered complete, 2Checkout.com requires that you also submit a clear, full color copies of your driver's license/government issued identification and your international passport. If there is more than one principal listed on the form, each principal will be required to submit valid identification. This identification is needed to validate the information entered on the Risk form.
Once you have prepared this information, you may e-mail the color scans to: Risk@2CO.com “Re: Risk Documentation” along with your vendor account number.
You may include the Risk forms when you e-mail the color scans, or you may fax them to: (614) 921-2451 (International) or (866) 921-2451 (US & Canada) Attn: Risk “Re: Risk Documentation” along with your vendor account number.
Rev 081707 2Checkout.com, Inc. Vendor Risk Management Documentation
2Checkout.com, Inc. 1785 O’Brien Road
Columbus Ohio 43228
FAX: 1-614-921-2451
Company Information
Vendor Name: __________________
Company Legal Name: ________________________________________________
Taxpayer ID#: _____________ 2Checkout StoreID # _______________
D/B/A Name(s):_____________
Address:___________________
City:______ State/ZIP:________
Telephone (Contact)_________ Telephone (Customer Svc):________
Fax Number:_________ Web URL:__________
Contact Email Address:_________ Alternate Email Address:_________
Legal Entity Type: C Corp LLC Partnership S Corp Sole Proprietorship
Business Incorporated: Public Private Non-Profit
Year Started:___________
Date of Incorporation:__________ State Incorporated:_______________
Dun & Bradstreet #:________________
Has the company ever filed bankruptcy? Yes No
Please list all principals and their percentage of ownership (attach separate form is additional space is required):___________________
Name __________ %age _________ SS#, Government ID # or Passport Number ___________
Name __________ %age _________ SS#, Government ID # or Passport Number __________
Principal Street _____________________
Principal City____________
Principal State/ZIP_____________
Principal Second ID_____________
(Driver’s License# and State _____________
Have any of the principal officers ever filed bankruptcy? Yes No
If “Yes,” individual(s) involved and year filed: _________________
If you were previously contracted with an alternate service to 2Co please identify the company.
___________________________________
Have you previously or do you currently possess a merchant account? If so with who?
______________________________________
Please provide a detailed description of any/all goods or services being rendered through the account:
I, ______________________________________, do attest that the information provided is correct.
__________________________________________ _______________________________
Signature Date ___________
Rev 081707 2Checkout.com, Inc. Vendor Risk Management Documentation
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