Signup Form

Signup Form

Provide your business and owner details to set up your merchant account.
Company Name
DBA Name
Business Structure
Type of Business
Average Transaction Amount (USD)
Highest Transaction Amount (USD)
Average Monthly Amount (USD)
Company Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Email Address
example@example.com
Business Website
Business Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Federal Tax ID (EIN)
Owner's Legal Name

First NameLast Name
Owner's Social Security Number
Ownership Percentage
Owner's Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Email Address
example@example.com
Owner's Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Desired method(s) of accepting payments

Other
Are there any additional owners?
Owner 2 Legal Name

First NameLast Name
Owner 2 Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Owner 2 Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner 2 Email Address
example@example.com
Owner 2 Ownership Percentage
Owner 2 Social Security Number
How did you hear about us?
Additional Comments
Upload a voided check (for deposit verification)

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Upload a Photo ID

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Please review all information carefully before submitting. Final signature request is sent separately through the processor’s portal.
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