HigginsPay Application Form

HigginsPay Application Form

Lowest Merchant Rate Guaranteed. 24-7 Service.
Business Information

This section aims to gather pertinent information about your business.
Merchant Program Type
Business DBA Name
Business Legal Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Type:
Business Number:
Please enter a valid phone number.Format: (000) 000-0000.
Business Email:
example@example.com
Bank Routing Number
Matches Void Check
Account Number
Matches Void Check
Business EIN Number
Products/Services Sold
Years Business Open
Equipment Required (If you need equipment, a representative will contact you for more information)
Owners / Officers Information

This section aims to gather pertinent information about your business leaders.
Owner / Officer Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner / Officer Email
example@example.com
Owner / Officer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Number for Account
Date of Birth

MonthDayYear
Date
Social Security Number
XXX-XX-XXXX
Higgins Opt-In Programs

This section identified the higgins.ai programs you are enrolling in.
Higgins Opt-In Programs

Other
Higgins Opt-In Programs are described along with costs and details on the Higgins Opt-Ins Site.
Upload ID (Driver's Licence), Void Cheque and a Merchant Statement (If you want to know how much you will save!)

Upload ID (Driver's Licence), Void Cheque and Merchant Statement
Cancelof
Signature
All use of this data is governed by the Higgins AI Privacy Rules and any questions can be sent to privacy@higgins.ai for rapid response. By signing this form, I agree to the terms & conditions.*
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HigginsPay Application Form

Business Information

Owners / Officers Information

Higgins Opt-In Programs