Compass Payment Services Online Application
APPLICANT INFORMATION
BUSINESS & PERSONAL INFORMATION
ELECTRONIC SIGNATURE AND DISCLOSURES
Legal Business Name
Legal Business Name
DBA Name
DBA Name
Street
Street
City
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Zip #
Zip #
Contact Person
Contact Person
Business Phone
Business Phone
Cell Phone
Cell Phone
Title
Title
Email
Email
Website
Website
DOT #
DOT #
MC #
MC #
Federal Tax ID
Federal Tax ID
Years in Business
Years in Business
Number of Trucks
Number of Trucks
Number of Drivers
Number of Drivers
Team/Slip Seat
Weekly Fuel Usage
Weekly Fuel Usage
Weekly Cash Usage
$
Weekly Cash Usage
Company Annual Revenue
$
Company Annual Revenue
Please Select ALL Compass Entities you work with currently:
COMPASS TRUCK RENTAL & LEASING
COMPASS TRUCK SALES
COMPASS PAYMENT SERVICES
COMPASS INSURANCE GROUP
COMPASS LEASE
COMPASS EQUIPMENT FINANCE
COMPASS LOGISTICS
SMARTBOARD
Have you ever had or applied for CPS account?
YES
NO
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