Merchant Application

Merchant Application

Form Encrypted Using 2,048 bit SSL
Banks now requiring minimum of 1 year in business
Legal Entity Name *
DBA Name
Business Phone Number *

Area Code Phone Number
Legal Entity Address *

Street Address

Street Address Line 2

City State

Zip Code
Incorporation State *
Federal Tax ID *
Start Date *

Month Day Year
Owner Information
Full Name *

First Name Last Name
Title *
Email *
Percentage of Ownership *
Current Ownership Start Date *

Month Day Year
Date of Birth *

Month Day Year
Current Residence Address *

Street Address

Street Address Line 2

City State

Zip Code
Owner Mobile Number *

Area Code Phone Number
Authorized Contact
Full Name

First Name Last Name
Email
Phone Number

Area Code Phone Number
Required Documents
Copy of Voided Business Check *

Select Files
The Name Must Match the Business Name Cancel of
Driver's License *

Select Files

Cancel of
Business Articles of Incorporation *

Select Files

Cancel of

Owner Information