Dwello - Vendor Onboarding Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Company Name *Contact Person *FirstLastCompany Structure *--- Select Choice ---CorporationLLC (Limited Liability Company)PartnershipSole ProprietorshipJoint VentureTraditional PartnershipLimited PartnershipLimited Liability PartnershipState of Incorporation/Organization *--- Select Choice ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCompany WebsiteContact Email *Contact PhoneAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFederal Employer Identification Number (XX-XXXXXXX) * Licensing Company Structure If applicable, upload picture of your cancelled check Drag & Drop Files, Choose Files to Upload Licensing and Compliance Policies (e.g., contractor licenses and customer data protection policies) Drag & Drop Files, Choose Files to Upload You can upload up to 25 files. Please provide copies of all final, signed compliance policies, including any regulatory, insurer, or customer notices alleging violations of law or regulation, along with a brief description of any remediation taken (if applicable). Please also provide the following policies and disclosures, as applicable: Privacy Policy; Complaint Policy and complaint log; Compliance Training Policy; Compliance Management System (CMS); Vendor Risk Management Policy or program; Corrective Action Policy; and Audit / Monitoring and Testing Policy. Finally, please provide any customer-facing scripts, disclosures, or materials that will be used in connection with this relationship.General Liability Insurance * Drag & Drop Files, Choose Files to Upload Please provide proof of general liability insurance in an amount commensurate with the risk involved in the conduct and operation of your business.Merchant Financials Drag & Drop Files, Choose Files to Upload Audited financial statements may be required for larger merchants or merchants generating significant loan volume, while unaudited financials and tax returns are acceptable for small and mid-sized merchants.Signature * Clear Signature I certify all of the above information in this form are true and accurate.Submit