MERCHANT DEPOSIT CAPTURE APPLICATION
Submitter Information
First Name (required)
Last Name (required)
Resolve the errors marked in red before submitting again.
Company Information
Legal Name of Business
 
Company/Doing Business As
 
Website Address
 
Number of years in business
 
Number of years at TrustTexas Bank
 
Business Address (required)
Mailing Address (if different than Business Address)
Business PhoneBusiness FaxPrimary Applicant's Direct PhoneFederal Tax ID

 
Do you offer products and services outside the United States?
Have you filed for bankruptcy in the past seven years?
Does your company currrently use our Business Internet Banking system? (required)
Does your company currently use our ACH or wire services?
Do you use Merchant Capture at another Financial Institution?
Do you perform background checks on new employees?
Is a photo ID required for employment?
Are photo IDs worn in the workplace?
Enter the name of the person authorized to agree to the contract later in the application.
Primary Applicant
Authorized Person
 
Authorized Person's Title
 
Social Security Number
 
Email
 
Location NameAddressCityStateZip CodeExpected Start Date
Location 1
 
Location 2
 
Location 3
 
Location 4
 
The Primary Contact information is required. All other contacts are optional and will be filled in with the Primary Contact information if none are provided.
Notification of any deposit corrections will be sent to either the fax number or the Email address listed.
Primary ContactSecondary ContactDeposit Corrections
Name
 
Title
 
Phone
 
Fax
 
Email
 
Social Security Number
 
To open an account contact your nearest TrustTexas Bank branch location.
Account Number
Account Number
 
Use this account as your billing account? (required)
Use this account for the following locations
PLEASE ESTIMATE THE FOLLOWING "AVERAGE" INFORMATION.
Number of Workstations
 
Deposit Days
 
Items per Deposit
 
Dollar Volume per day
 
Number of Scanners to be usedMake & Model of Scanner(s)

 
Do you have wireless Internet access?
What operating systems do you use on computers connected to the scanners?
Do you keep updated antivirus software on your computers?
Do all computers use a firewall?
Do you perform IT audits?
If yes, please supply financial institution with a copy of latest audit.
Do you have IT staff onsite?
Do you offer VPN or remote access for staff?
Each person must be assigned their own token to originate ACH File Transfers.
How many tokens are needed?
 
Token User 1Token User 2Token User 3Token User 4
Name
 
Phone
 
Email
 
Do you plan to mark or "frank" each paper check after it has been successfully issued to the financial institution?
How long do you plan to store the original checks after depositing?
Will your original checks be stored in a locked and secure location after scanning?
What method will you use to securely destroy original checks after the retention period?
I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. I authorize the Financial Institution to make any credit or investigative inquiry that the Financial Institution determines appropriate. I understand that I must update the information listed above at your request and if my financial condition changes.

 
Primary Applicant's SignatureDate