Account Setup Form http://<form action=”https://formsubmit.co/abrown@innersoulbs.com” method=”POST” style=”max-width: 650px; margin: 0 auto; font-family: Arial, sans-serif;”> <!– Form Configuration Settings –> <input type=”hidden” name=”_subject” value=”New Stripe Setup Form Submission”> <input type=”hidden” name=”_template” value=”table”> <input type=”hidden” name=”_captcha” value=”false”> <h2>Stripe Account Setup Form</h2> <p><em>Tip: Tap any field on your phone or tablet and use the microphone icon on your keyboard to speak your answers.</em></p> <!– 1. Business Information –> <fieldset style=”margin-bottom: 20px; padding: 15px; border-radius: 6px; border: 1px solid #ccc;”> <legend style=”font-weight: bold;”>1. Business Information</legend> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Legal Business Name *</label> <input type=”text” name=”Legal_Business_Name” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>DBA / Display Name (Name shown on receipts)</label> <input type=”text” name=”DBA_Name” style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Business Structure *</label> <input type=”text” name=”Business_Structure” placeholder=”e.g. LLC, Sole Proprietorship, Corp” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Tax ID (EIN or SSN) *</label> <input type=”text” name=”Tax_ID” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Business Physical Address *</label> <input type=”text” name=”Business_Address” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Business Phone Number *</label> <input type=”tel” name=”Business_Phone” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Website or Social Media Link</label> <input type=”text” name=”Website_URL” style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Product / Service Description *</label> <textarea name=”Product_Description” rows=”3″ required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”></textarea> </div> </fieldset> <!– 2. Representative Information –> <fieldset style=”margin-bottom: 20px; padding: 15px; border-radius: 6px; border: 1px solid #ccc;”> <legend style=”font-weight: bold;”>2. Authorized Business Representative</legend> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Full Legal Name *</label> <input type=”text” name=”Rep_Full_Name” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Job Title / Role *</label> <input type=”text” name=”Rep_Job_Title” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Email Address *</label> <input type=”email” name=”Rep_Email” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Direct Phone Number *</label> <input type=”tel” name=”Rep_Phone” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Date of Birth *</label> <input type=”text” name=”Rep_DOB” placeholder=”MM/DD/YYYY” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Home Physical Address *</label> <input type=”text” name=”Rep_Home_Address” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Last 4 Digits of SSN *</label> <input type=”text” name=”Rep_SSN_Last4″ maxlength=”4″ required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> <small style=”color:#666;”>Required by Stripe for identity verification</small> </div> </fieldset> <!– 3. Bank Account Information –> <fieldset style=”margin-bottom: 20px; padding: 15px; border-radius: 6px; border: 1px solid #ccc;”> <legend style=”font-weight: bold;”>3. Bank Account Information (Payouts)</legend> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Bank Name *</label> <input type=”text” name=”Bank_Name” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Account Holder Name *</label> <input type=”text” name=”Bank_Account_Holder” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Routing Number *</label> <input type=”text” name=”Bank_Routing_Number” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Account Number *</label> <input type=”text” name=”Bank_Account_Number” required style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> </fieldset> <!– 4. Existing Account –> <fieldset style=”margin-bottom: 20px; padding: 15px; border-radius: 6px; border: 1px solid #ccc;”> <legend style=”font-weight: bold;”>4. Existing Stripe Account (Optional)</legend> <div style=”margin-bottom: 12px;”> <label style=”display:block; font-weight:bold;”>Existing Stripe Account Email</label> <input type=”email” name=”Existing_Stripe_Email” placeholder=”Only if you already have an active Stripe login” style=”width:100%; padding:8px; border:1px solid #ccc; border-radius:4px;”> </div> </fieldset> <button type=”submit” style=”background:#0f172a; color:#fff; padding:12px 24px; border:none; border-radius:4px; font-size:16px; cursor:pointer;”>Submit Information</button> </form>
