Pre-Application for Merchant Services
Please provide all required details to begin the application process. Upon receipt, we will review and email you a click-to-agree application.
Business Information
Enter your business information here.
Ownership Type
*
Please Select
Sole Prop
LLC
Private Corporation
Non- Profit
Tax ID
*
Enter your Tax ID Number
Business DBA Name
*
Legal Business Name
*
Business Start Date
*
-
Month
-
Day
Year
Date
Enter Company Website
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business E-mail
*
example@example.com
Optional Business Contact (Manager or Partner, etc.)
First Name
Last Name
Contact Number
Format: (000) 000-0000.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Optional Business Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant Information
Example: Owner/Corporate Officer/CFO with signing authority.
Signor Full Name
*
First Name
Last Name
SSN
*
DOB
*
-
Month
-
Day
Year
Date
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Banking Info
Bank Name
*
Routing Number
*
Account Number
*
Please upload a picture of your business check or signed bank letter where funds will be deposited.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Processing Info
Products/Services Sold
*
AVG Monthly Credit Card Volume
*
AVG Transaction Amount
*
Estimated High Ticket Amount
*
Submit Pre-Application Form
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