App – 5 – Tranzpay

Owner/Officers #4

All persons who directly or indirectly own 25% of greater equity interest must be added, and if applicable, all persons with significant responsibility to control, manage or direct the business (Controller).

Name*

First Last

Title*

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Telephone*

Drivers Licence Number*

Social Security Number*

Date of Birth*

Equity/ Ownership %*

Please enter a number from 0 to 100.

Owner #4 Email Address*

Required for collecting signature via Docusign.