Application Details:
We'll use this to build your application and send to you for review and signature via DocuSign. Please make sure to provide a copy of the Driver's license and copy of the business voided check
DBA/Business Name
*
(Doing Business As)
Contact - Full Name
*
First Name
Last Name
Contact - E-mail
example@example.com
Contact - Phone Number
*
Format: (000) 000-0000.
Business Legal Name
Please put the legal name of your business
Tax Filing Method
*
EIN (Tax ID)
SSN (Social Security)
ITIN
Tax Filing #
*
(EIN,SSN,or ITIN)
Business Description
*
(What are you selling?)
Business Start Date
*
Business Phone Number
*
Format: (000) 000-0000.
Website
(necessary if you are processing through a website)
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business LEGAL Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
OWNER Name
*
First Name
Last Name
OWNER Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner DOB
*
Date of Birth
OWNER SSN
*
(social security number or ITIN)
OWNER Cell Phone
*
OWNER Email
*
example@example.com
BANK Name
*
Where funds will be deposited
BANK Routing Number
*
BANK Account Number
*
Average Monthly Card Volume
*
How much do you process/anticipate in card volume a month?
Average Transaction Amount
*
How much is 1 normal transaction for?
HIGHEST Transaction Amount
*
What would be the aproximate highest ticket that you will process? Please be as precise as possible
Please select if the merchant wants to be billed daily or monthly
Daily Frequency (Fees will occur on a daily basis)
Monthly Frequency (Fees will occur on a monthly basis)
When is Card Charged?
In Advance
When Service/Product Provided
Other
Services Generally Provided in:
0-7 Days
8-14 Days
15-30 Days
Over 30 Days
Refund Policy
Exchange Only
No Refund or Exchange
More than 30 days
30 Days or Less
Transactions are run (must equal 100%):
*
% In-Person
*
% Telephone
*
% Online
Location information - Building type
*
Shopping Center
Office Building
Industrial Building
Residence
Location Information:
*
Owns
Rents
Location Information - Area zoned
*
Commercial
Residence
Square footage:
*
0-1000
1000+
Type of Equipment you're getting:
If you do not know, please leave blank and we'll contact you or fill in on our end.
Any special notes you'd like us to know?
Submit
Should be Empty: