Priority Payment Authorization

The application will take about five minutes to complete.
At the end of the application, you can upload the documents needed,
or you can fax it to (800) 334-9364 or email@prioritypaysystems.com

Any questions contact me at 1-407-902-9298
John Honeycutt

All information in the application is Secure and Encrypted

Business Information

Busines Name or DBA

Tax Filing Name, if different

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Phone Number

Please enter a valid phone number.

Business Email

example@example.com

Description of the Products or Services you offer:

EIN or TAX ID

Date Business Started

Type of Company

(LLC, Corporation, etc.)

Owner or Representative Information

Owner or Representative Name

First NameLast Name

Home Address (Owner or Representative)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address (Owner or Representative)

example@example.com

Social Security Number (Owner or Representative)

Date of Birth (Owner or Representative)

Drivers License Number and State (Owner or Representative)

Processing Information

Estimate your Average Monthly Credit/Debit Cards Sales

Estimate your Highest Sale Amount on a Credit/Debit Card

Upload Section

Please Upload a Voided Check or Bank Letter

Please Upload an Image of the Front of your Drivers License

Please Upload Statements if requested (3 months minimum, 6 months is ideal)

Authorization: I/we authorize John Honeycutt, representing Priority Payment Systems to setup our merchant account, according to the services I have selected, and to transfer and deposit funds. There is no contract and no obligation.

Signature - please sign with your mouse. Thank You.