Secure Online Appication

Merchant Services

Select Your Interchange Plus Pricing Plan
Interchange plus pricing covers V/MC/D & PIN Debit. *

0.10% + $0.10 + $15.00 Per Month 0.05% + $0.05% + $20.00 Per Month 0.00% + $0.05 + $30.00 Per Month

Other Fees:

American Express OptBlue: 0.50% + $0.10

International Card Handling: 0.50% + $0.10

Return Item/NSF (per occurence): $20.00

Account Maintenance (per occurence): $25.00 (update to DDA, DBA, or EIN)

Chargeback (per occurence): $25.00

Dial Communication (per occurence): $0.05

2nd Day Air (per occurence): $25.00

Non-PCI Compliance (per month): $74.99 (must validate within 90 days & renew annually)

Tell us how you want to process credit card transactions. You'll be able to confirm / change your selections before activation. Additional fees may apply.

Credit terminal Payment app on my mobile device Point of Sale System Payment gateway / virtual terminal A specific payment gateway, like Authorize.Net Reprogram an existing terminal / gateway / pos system Other

Business Information
Business Name (DBA) *
Contact Name *

First Name Last Name
DBA Address Type *
DBA Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email Address *
example@example.com
DBA Phone *
Please enter a valid phone number.
Mobile Phone
Please enter a valid phone number.
Website Address
Legal Name *
Ownership Type *
Tax Identification ID # *
If you are a sole proprietor, enter SSN
Year Established *
Length of Current Ownership: blanks* years. blank* months.
Country of Primary Business Operations *
Business Country of Formation *
Description of product or service *
Annual Revenue *
Monthly Sales on Credit Card *
Average Sale Amount *
High Sale Amount *
Number of High Sales Per Year *
How many days does it take for customers to receive products (include shipping) *
Card Acceptance Method (must total 100%) *

Ownership Information
Principal 1 Information (include all additional owners with 25% or more ownership) *

First Name Middle Name Last Name
Ownership Percentage *
Principal Type *
Title *
Home Address Type *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Previous Address if Current Address is Less Than 2 Years Old

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Home or Mobile Phone Number *
Please enter a valid phone number.
Date of Birth *

Month Day Year
Date
US Person *
SSN *
Identification Document
Document Number
Issuing Country (if applicable)
Issuing State (if applicable)
Issuing Date

Month Day Year
Date
Expiration Date

Month Day Year
Date

Principal 2 Information (include all additional owners with 25% or more ownership)
Principal 2 Information (include all additional owners with 25% or more ownership)

First Name Middle Name Last Name
Ownership Percentage
Principal Type
Title
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Previous Address if Current Address is Less Than 2 Years Old

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home or Mobile Phone Number
Please enter a valid phone number.
Date of Birth

Month Day Year
Date
US Person
SSN
Identification Document
Document Number
Issuing Country (if applicable)
Issuing State (if applicable)
Issuing Date

Month Day Year
Date
Expiration Date

Month Day Year
Date

Principal 3 Information (include all additional owners with 25% or more ownership)
Principal 3 Information (include all additional owners with 25% or more ownership)

First Name Middle Name Last Name
Ownership Percentage
Principal Type
Title
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Previous Address if Current Address is Less Than 2 Years Old

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home or Mobile Phone Number
Please enter a valid phone number.
Date of Birth

Month Day Year
Date
US Person
SSN
Identification Document
Document Number
Issuing Country (if applicable)
Issuing State (if applicable)
Issuing Date

Month Day Year
Date
Expiration Date

Month Day Year
Date

Funding
Deposit Bank Name *
ABA/Routing Number *
DDA Account Number *
Select Funding *

Standard (2 Business Days) included Next Business Day $10.00 per month Same Day $12.00 per month

Proof of Business: Please provide one proof of business.

Articles of Incorporation or any government issued business, sales, tax, etc. license matching business name and address. Business proofs are not required for a sole proprietor.
Business Proof Upload

Do not upload your driver license / photo ID
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Merchant Services