FUNDRAISING DISTRIBUTOR REGISTRATION

DISTRIBUTOR COMPANY INFORMATION
Supporters will receive receipts with your DISTRIBUTOR COMPANY INFORMATION.
Distributor Company Name:*
Distributor Company Address:* (PO Boxes cannot be used)
Distributor Company City:*
Distributor Company State:*
Distributor Company Zip:*
Distributor Company Support Email:*
Distributor Company Phone:*
Distributor Company Phone Ext:
Distributor Company Tax ID:* Employer Identification #, EIN  

DISTRIBUTOR COMPANY ADMINISTRATOR INFORMATION
(person with authority and responsible for setting up the accounts with PTY and ProPay)
Admin First Name:*
Admin Last Name:*
Password:*  (Minimum 8 characters and must contain one uppercase, lowercase, number and special character)  
Confirm Password:*
Admin DayTime Phone:*
Admin Evening Phone:*
Admin Email:*
Confirm Admin Email:*
Admin Social Security Number:*
Admin Date of Birth:*

DISTRIBUTOR COMPANY FINANCIAL INFORMATION
Distributor Company Banking Routing Number:* 
Distributor Company Banking Account Number:* 
Credit card is used for $5 annual fee payment to ProPay. Next annual payment method can be changed through ProPay.
Credit Card Type:*
Credit Card Number:*
CVV2:*

PROCESSING LIMIT

After approval from ProPay, you will have an account with ProPay with a preset processing limit of $10,000 per month. If you are confident you will need more than $10,000 per month, check the box below and ProPay will contact you for further underwriting. If ProPay has not contacted you within 3 days of account approval, please contact ProPay and provide your ProPay Account ID# and request an increase.


I have read and agree to the Terms and Conditions*
You will add your fundraising clients to your account, once you have been approved.