• Sign-Up Form

    Sign-Up Form

  • NOTICE

    Before you begin, please ensure you have the necessary documents and information ready. You will need your location's information, a copy of a voided check/bank letter, as well as your sales breakdown (Gross Annual Sales, Average Sale, etc.). Having these prepared in advance will help ensure a smooth and efficient submission process.
  • Primary Contact

  • Business Information

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  • Additional Business Information

  • Ownership Information

    Each individual, if any, who owns, directly or indirectly, 25 percent or more of the equity interests of the legal entity customer (e.g., each natural person that owns 25 percent or more of the shares of a corporation). If more than one applicable owners, please contact info@emeraldpay.com for further instructions after submitting with the primary owner/signer.
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  • Banking/Financial Information

  • Banking Information

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  • Financial Information

    Estimated values are accepted, exact amounts are not required (i.e. $1,556,976.54 in Gross Yearly Sales Volume can be reported as $1,500,000)
  • Equipment

    All prices listed do not include applicable taxes and shipping fees. With the purchase of a Clover device, you'll gain immediate access to the Clover Dashboard, Virtual Terminal, and Clover Go App for an additional $5.00/month.
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    Clover Compact Product Image
    Clover CompactBest Cost Effective Device
    $300.00
      
    Clover Flex Product Image
    Clover Flex
    $713.10
      
    Clover Mini Product Image
    Clover Mini
    $1,041.35
      
    Clover Mini  With Cash Drawer Product Image
    Clover Mini With Cash Drawer
    $1,141.35
      
    Clover Go Product Image
    Clover GoBest Option for Services/Contracctors
    $150.00
      
    Kitchen Printer Product Image
    Kitchen Printer
    $516.00
      
    Clover Station Duo with Cash Drawer Product Image
    Clover Station Duo with Cash DrawerBest Option for Retail
    $2,010.10
      
    Total
    $0.00
  • Additional Documents & Signatures

    Please review the agreement PDF before submitting. Partially completed or unsubmitted forms will not be recorded. After submission, you can download a copy of the agreement, and a copy will also be emailed to you.
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  • Additional Documentation

    Voided Check or Bank Letter required. Starter checks will not be accepted. A bank letter must have a bank letterhead, the company's name, routing number, bank account number, and signature from a bank representative.
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