Merchant Application

Business Information

Complete our quick online application so we can begin processing your information. You can also call us during normal business hours to speak with a business consultant.

Business Phone: *Please enter a valid phone number.

Business Email: *Email that matches your business webpage.

Business Website: *Company Website.

Business Address: *Street Address

Equipment/Software for Card Processing: *Please list equipment and/or software used to process cards (point-of-sale, terminal, payment gateway, etc.)

Please describe your refund and return policy: *Refund and Return Policy

Principal Information

Please list all principals who, directly or indirectly, through any contract, arrangement, understanding,relationship or otherwise, own 25% or more of the equity interests of the legal entity listed in this application.

1. Principal Full Name: *First Name

.Middle Name

. *Last Name

Date of Birth: *1. Pricipal Date of Birth

Ownership % *

Have you (your business or any principal) filed bankruptcy? *

Business BankruptcyPersonal BankruptcyNever

Home Address: *Street Address

2. Principal Full Name: *First Name

.Middle Name

. *Last Name

Date of Birth: *1. Pricipal Date of Birth

Ownership % *

Have you (your business or any principal) filed bankruptcy? *

Business BankruptcyPersonal BankruptcyNever

Home Address: *Street Address

Processing Information

This section pertains to information about your business’s credit card processing and acceptance.

Are You Currently Accepting Credit Cards: *

Name of Processor: *Who is your processor today?

Account Type: *RetailMOTO (Mail Order Telephone Order)Internet

Business Structure: *Sole ProprietorPartnershipCorporationNon-Profit

Estimated Average Ticket Amount: *Up to $20.00$20.00 - $50.00$50.00 - $500.00$500.00+

Building Type: *Shopping CenterOffice BuildingIndustrial BuildingResidence

Building Ownership: *OwnsRents

Inventory Maintained: *

On-SiteOff-Site (i.e. Warehouse)3rd Party Fulfillment CenterService Only (No Products Sold)

Are there any other companies involved in shipping or fulfilling product/service (i.e. fulfillment center)? *YesNo

Do you offer recurring and time-extended services (subscriptions, memberships, recurring plans,etc.? *YesNo

Merchants Online Application

Business Information

Principal Information

Have you (your business or any principal) filed bankruptcy? *

Have you (your business or any principal) filed bankruptcy? *

Processing Information

Inventory Maintained: *