Shepherd Pay Intake Form

Please complete the form below to submit your business information to Shepherd Pay. Ensure that all fields are filled out to the best of your ability. If you have any questions, feel free to reach out to us at 732-323-8300.

Void Check/Bank Letter:

A copy of a check or a verification letter from the bank is required to confirm the bank account and routing number. This is a standard practice to ensure that the numbers are correct. The voided check should include the following: 1. Printed name of the practice (DBA Name), 2. Bank name, 3. Account number, 4. Routing number. If a bank verification letter is being provided, it should be written on bank letterhead and include the following: 1. Practice’s name (DBA Name), 2. Account and routing numbers, 3. Banker Signature

Practice Owner/Signer’s Personal Information:

The U.S. Patriot Act requires that all US merchant accounts need to be tied to a US citizen or residential alien. To validate this, the signer's full legal name, home address, phone number, and social security number are required.

Credit Pull: To confirm that everything matches, a soft credit pull is performed. This soft credit pull does not affect the signer's credit score. For this to be completed, the signer’s credit can not be frozen or have any blocks on it. If there are blocks, the account will not be able to be approved until the blocks are removed.

Business Legal Name and Tax ID:

The IRS requires that all transactions are reported for tax purposes. The legal information entered on this form will be checked against the IRS’s database to ensure that it matches before approving the account. If it does not, a copy of the practice’s SS-4 document (EIN letter), or other supporting documents may be needed.

Business DBA (Doing Business As) Address:

This should be the address that the practice is located at. For mobile veterinarians, the signer’s home address should be entered. For all other practices, it should be the physical address of the practice. PO boxes are not accepted as a business can’t operate out of one. If the practice is a startup, the future location of the business can be provided.

Business Corporate Information

This is the information of the incorporated entity.

Business DBA (Doing Business As) Information

This is the information of the business that will be displayed to the customer.

Upload Void Check
Signer's Information

Personal information of the main signer of the legal entity.

Estimated Transaction Information

Rough estimates of transaction volume and averages.