Trinity Merchant Services Agent Applicaon
1. Personal Informaon
(Please complete all elds, if a eld does not apply either enter NA or None in the space.)
Once you have completed, signed and send this in, a Company Representave will review and send a signed copy back to you.






!"#$%%

2. If you are applying as a Business
 !"#$!$
$%&'
If you will be working as an Individual and not as a Company, LLC, etc., skip part 2 and proceed to next page)
&!"'
"()##())#(*$* *%+,-
.)#$
.)#*$
/%(01!')
231231
+'))#(,!+
'-*(+'('
./0'!
()!
4!5,/