Merchant Application
Complete Your Business Details Below
Corporate / Legal Name
*
DBA Name (If different)
Ownership Type
*
Please Select
Individual
Partnership
Corporation
Government
LLC
Non-profit
Publicly Traded
Legal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your DBA (Doing Business As) information same as Corporate/Legal?
*
Yes
No
Not applicable
Business Location (if different than legal address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping address (if different) for Equipment
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Federal Tax ID / EIN
*
When was your business founded?
*
-
Month
-
Day
Year
Date
Website Address
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Principal Information
Please list all principals who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, own 25% or more of the equity interests of the legal entity listed in this application.
Owner Name
*
First Name
Last Name
Title
Please Select
CEO
Chairman
Co-Owner
Controller
Director
General Manager
Office Manager
Owner
Partner
President
Treasurer
Vice President
Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Address & Contact Information
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Ownership %
*
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Processing Information
This section pertains to information about your business’s credit card processing and acceptance.
Bank Name
*
Business Checking Number
*
Business Routing Number
*
Does this business currently accept credit cards?
Yes
No
Monthly Volume
*
Average Transaction Amount
*
Max Transaction Amount
*
Describe your product/service.
*
Primary Sales Method
*
In-person (card present)
Mail/Phone (card not present)
Internet/eCommerce (card not present)
Upload Voided Check or Direct Deposit form
*
Browse Files
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Upload ID or DL
*
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Upload Last 3 Months of Merchant/Bank Statements
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