Advanced Merchant Profile

Merchant Profile

The following information is used by underwriting to verify your business, set-up your merchant account, and ultimately allow you to accept digital payments.
Please enter all information in complete form. Missing or incomplete data may cause delays.

If you have any questions, please contact your support or sales representative.
Business Name (DBA)*
Name as it appears on the front door!
Primary Business Contact*

First NameLast Name
Contact Phone*

Area CodePhone Number
Contact Email*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Business Phone*

Area CodePhone Number
Business Website*
Legal Name / Corporate Name*
**MUST MATCH TAX FILING NAME EXACTLY** (Includes spaces, commas, lowercase and uppercase)
Legal Entity Formation Date*

MonthDayYear
Date
Corporate/Legal Address*

Street Address

Street Address Line 2

CityState

Zip Code
Federal Tax ID Number*
Please use format XX-XXXXXXX
Date Business Opened *

MonthDayYear
If unknown, select closest estimate.
Number of Year Under Current Ownership*
Business Structure*
Owner's Information

Owners/Partners/Officers
All signers with a 25% or greater ownership, must be included.

If no partners are 25% or greater, complete the "Owner 1" field as the Control Person.

Control Person: an individual with significant responsibility for managing the business, such as an executive officer or senior
manager (e.g., CEO, CFO, COO, Managing Member, General Partner, President, VP, Treasurer); or any other individual who regularly performs similar functions.

This requirement is due to Anti-Money Laundering laws and Know Your Customer regulations.

Owner #1 Information / Control Person
Owner #1 Name*

First NameLast Name
Owner #1 Title*
Owner #1 Date of Birth*

MonthDayYear
Date
Owner #1 Social Security Number (SSN)*
Please use format XXX-XX-XXXX
Please Note: Your FULL social security number is required to process the application for underwriting. Partial or inaccurate completion will result in delays.

All data is encrypted when submitted for your security.
Owner #1 Percentage Ownership*
Owner #1 Cell Phone*

Area CodePhone Number
Owner #1 Email*
Must be a valid address, owned by the person above. A secure e-signature will be sent for final authorization to this account. Mismatched emails will cause set-up delays.
Owner #1 Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Owner #2 Information (if applicable)
Owner #2 Name

First NameLast Name
Owner #2 Title
Owner #2 Date of Birth

MonthDayYear
Date
Owner #2 Social Security Number (SSN)
Please use format XXX-XX-XXXX
Please Note: Your FULL social security number is required to process the application for underwriting. Partial or inaccurate completion will result in delays.

All data is encrypted when submitted for your security.
Owner #2 Percentage Ownership
Owner #2 Cell Phone

Area CodePhone Number
Owner #2 Email
Must be a valid address, owned by the person above. A secure e-signature will be sent for final authorization to this account. Mismatched emails will cause set-up delays.
Owner #2 Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Nature of the Business

Please complete all information. The information below can be estimated, however it is important that it NOT be left blank. This data is used to set risk parameters, and helps eliminate delays in funding.
Describe precisely what product/service you offer*
Describe precisely how your product/service is marketed and sold:*
Explain your customer service department and how complaints are handled:*
Explain your refund policy:*
Customer Service Manager Name:*
Customer Service Manager Contact Email*
Customer Service Manager Contact Phone*
Type of Goods/Services*
Payment Types Currently Accepted (select all that apply)*

ACH/e-CheckPaper CheckVisaMasterCardDiscoverAmerican ExpressWire (U.S.)Wire (International)Other
ERP Software*
ex. Microsoft GP, Deltek, NetSuite, Salesforce, Quickbooks, etc.
Online/E-Commerce Software (if applicable)
ex. WooCommerce, BigCommerce, self-created, etc.
Average Monthly Online Sales
Estimates are OK.
Volume Averages

Please submit accurate data. Data is used to set risk parameters for your account.
Paper Check
If you do not accept paper checks, place "$0.00" in the field.
What Types of Payments do you accept via Check? (select all that apply)*

One-Time Payments (i.e. payment for an invoice)Recurring Payment - MonthlyRecurring Payment - QuarterlyRecurring Payment - AnnuallyWe do not accept Check Payments
Average Check Payment Size (amount paid on single invoice)*
Estimates are OK.
Average Monthly Check Payment Sales*
Estimates are OK.
Highest Check Payment Transaction*
Consider high ticket volume from large projects. Estimates are OK.
What percentage of your annual revenue is received via Check payment?*
Consider the information provided above. Estimates are OK.
Credit/Debit Card Payment Details
If you do not accept card payments currently, place "$0.00" in the field.
What Types of Payments do you accept via Card?*

One-Time Payments (i.e. payment for an invoice)Recurring Payment - MonthlyRecurring Payment - QuarterlyRecurring Payment - AnnuallyWe do not accept Card Payments
Average Card Payment Size (amount paid on single invoice/transaction)*
Estimates are OK.
Average Monthly Card Payment Sales*
Estimates are OK.
Highest Card Payment Transaction*
Consider high ticket volume from large projects. Estimates are OK.
Percentage of Card Not-Present Transactions*
% of cards you accept online through e-Commerce, via portal, over the phone, etc. vs. in-person via swipe/chip/tap. Be sure to include all of your online sales (from above) if they are accepted via card. Estimates are OK.
What percentage of your annual revenue is received via Card payment?*
Consider the information provided above. Estimates are OK.
ACH/e-Check Payment Details
If you do not accept ACH/Electronic Check payments currently, place "$0.00" in the field.
What Types of Payments do you accept via ACH/e-Check?*

One-Time Payments (i.e. payment for an invoice)Recurring Payment - MonthlyRecurring Payment - QuarterlyRecurring Payment - AnnuallyWe do not accept ACH or e-Check Payments
Average ACH/e-Check Transaction Size (amount paid on single invoice/transaction)*
Estimates are OK.
Average Monthly ACH/e-Check Payment Sales*
Estimates are OK.
Maximum Monthly ACH/e-Check Payment Volume Need in One Month*
Maximum Number of Transactions Needed per Day*
Highest Single ACH/e-Check Payment Transaction Expected*
Estimates are OK.
What percentage of your annual revenue is received via ACH/e-Check payment?*
Consider the information provided above. Estimates are OK.
Bank Information

The following account information will be used for your payment deposits and fee withdrawals for both ACH and Card Payments. A copy of the voided check for this account will be requested in the next section. Please ensure the information provided below matches exactly with the copy of your uploaded voided check.
Bank Name*
Name on Bank Account*
Account Type*
Routing Number*
9 Digit Number
Account Number*
Account Number is the ending number on most checks
Upload your supporting documentation below. These documents are securely submitted to underwriting for credit and account approval.

Please use the smallest, legible, file size available to you.
Files must be under 100MB. Supported file types include: pdf, doc, docx, zip, jpg, jpeg, png, gif
Invoice & Payment Receipt Uploads (Please upload copies of invoices that match your average transaction type. This should be for BOTH Card payments and ACH Payments.)
Copy of Invoices with Payment for Average transaction (dated within 30 days) Please provide as many examples as necessary.*

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Additional Upload for Invoice Copies

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Additional Upload for Invoice Copies

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Voided Check Upload (please ensure your check details match your account and routing information above.)
Upload a Copy of a Voided Check*

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Credit Card Statement Upload (this is merchant services statements for card acceptance, not for card spending0
Upload 3 Months Recent Credit Card Processing Statements and/or ACH Processing Statements (submit both if applicable)*

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Additional Upload for Credit Card Processing Statements

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Bank Statement Upload
Please provide bank statements for the corresponding legal entity.
Upload 3 Months Bank Statements*

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Additional Upload for Bank Statements

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Additional Upload for Bank Statements

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Financials Upload
Upload 2 years Audited Financials or Tax Returns*

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Additional Upload for Financials

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Upload copy of Company Operating Agreement

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Corporate Document Upload (although not all files are required, providing this documentation will expedite underwriting and provide for higher limits if you've requested large volumes or large transactions. Underwriting may still require this documentation in your review.)
Upload W-9 Form*

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Upload copy of Company Articles of Incorporation

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Upload copy of DBA Certification (if applicable)

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W-9 Upload
Upload copy of Signor(s) U.S. Driver's License*

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User Information

Please provide the information for each individual you would like to access our online merchant portal. This portal will show you real-time payment information, batches, deposits, chargebacks, ACH returns, and credit card statements. ACH statements are delivered separately via email. This portal has the ability to receive and send payments so it should not be provided only to who require access.

Please note: Cell Phone is required for 2-Factor Authentication. Users without a proper cell number will have issues accessing the secure website. Personal and business information is used only for the intended purpose.

	First Name	Last Name	Email	Cell Phone
User 1
User 2
User 3
User 4
User 5

Please provide any notes or special comments you may have regarding your submission.
To submit this form, verify all required fields have been fully completed and click "submit" below. You will receive a confirmation email shortly.
Should be Empty:

Merchant Profile

Owner's Information

Nature of the Business

Volume Averages

Bank Information

User Information