Merchant Processing Account Application
Please provide all required information to submit your application. After submitting your application our professional team will be in contact by either email or phone within 24-48 hours.
Business Information
Legal Business Name
*
DBA Business Name
*
Please provide a brief description of the business and business activity:
*
Business Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business E-mail
*
example@example.com
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Tax ID# (SS# if Sole Proprietorship)
*
Type Of Business Entity
*
Sole Proprietorship
Corporation
LLC
Partnership
Non-Profit
Business Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Average Monthly Sales Volume
*
Average Sale Transaction Amount (Average Price At Checkout Or Invoice)
*
Highest Transaction Amount
*
Business Banking Information
Business Bank
*
Routing Number
*
Account Number
*
Business Owner Information
Business Owner Name
*
First Name
Last Name
Business Owner's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Owner's PERSONAL Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Owner's Home Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Owner's Personal Email
*
Business Owner's Date Of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Business Owner's Social Security#
*
Ownership %
*
Notes / Docs
Sales Rep
*
First Name
Last Name
Equipment Shipment Location
*
Business Address
Owner Residential Address
Other
Equipment Shipment Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Final Notes
Equipment choices, quantities, shipping address, paperwork notes, etc
Voided Business Check (THIS WILL BE REQUIRED BEFORE A MERCHANT ACCOUNT CAN BE OPENED)
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Driver's License or Valid ID
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Proof of Business (EIN letter, Business License, or Articles of Organization)
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Save
Submit
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