Small Business Payments Group, LLC
Merchant Services Application Form (note: submitting this application does not commit you to anything, it simply allows us to provide you a detailed quote)
Corporate / Legal Name
*
DBA Name
*
EIN
*
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
Business Location (if different than legal address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When was your business founded?
*
-
Month
-
Day
Year
Date
Where do you prefer to receive mail?
*
DBA
Legal
Customer Service Telephone Number
*
Format: (000) 000-0000.
Website Address
*
Products and/or Services Sold
*
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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
Driver's License Number
*
SSN
*
Expiration Date
*
-
Month
-
Day
Year
Date
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 %
*
Is this the individual you want to list as management?
*
Yes
No
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Processing Information
This section pertains to information about your business’s credit card processing and acceptance.
Type a question
In-Person - Standalone Ingenico, $249.99
In-Person - Poynt Smart Device, $749.99
In-Person - Clover Device (submit application for detailed pricing due to frequent price fluctuations)
In-Person - Maximum Software + Hardware Bundle (submit application for details and appointment with a representative)
Email Invoice
On-the-Go
Online
Additional Accessories (cash drawers, receipt paper, KDS, etc. - please submit application and we will contact you to discuss additional details)
More than one terminal? Need to be wireless? Something else you want us to know? Tell us here!
Pricing Structure
*
Interchange-Plus (recommended) - Cost-Plus Pricing, Least Expensive (0.15%-0.35% plus costs is the most common range)
Fixed Rate - 3.25%
Surcharge (if qualified) - 3.5% Pass-Through to
Discount/Coupon Code
Your Industry Setup (contractor, restaurant, eCommerce, etc.)
*
Bank Account Number
*
Bank Account Number
*
Bank 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)
Percentage of Sales from International Customers
Please describe your refund and return policy.
*
Please list equipment and/or software used to process cards (point-of-sale, terminal, payment gateway, etc.)
Notes (Optional)
Voided Check
*
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Driver License
*
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Merchant Processing Statement (optional, but including three months of merchant processing statements improves likelihood of getting approved quickly and receiving the lowest possible rate)
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Submit
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