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Smart Payment Solutions for Your Business Success

Please fill out the form below to submit your applicaiton for a merchant account!

First Name *

Last Name *

Email *

Legal Entity Name *

Business Name AKA DBA (Doing Business As) *

Business Phone *

Type of Ownership *

Sole Proprietor
Partnership
Corporation
LLC/LLP
Non-Profit
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Full Business Address *

Business Email *

Physical Address Same as Corporate Address? *

Yes
No
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If your Physical address is different from the corporate address, enter it here:

Description of Product Sold *

Typical High-End Ticket *

Average Ticket Size *

Average Monthly Volume *

Recent Monthly Processing Statement (Required for High Ticket Limits and Free Equipment)

Bank Routing # *

Bank Name *

Bank Account # *

Picture of Voided Check *

Primary Owner's Full Name *

If your local residential address is different from the address on your driver’s license, enter it here:

Ownership % *

Social Security Number *

This is for ownership verification; a credit check is performed to verify ownership and to ensure you are not on the MATCH list. This requirement can be waived if necessary, but at least the last four digits of the Social Security Number must be provided. Providing the full SSN will expedite the process.

Owner Driver's License *

TIN # *

Date Business Started *

Are you comfortable proceeding with a credit check as part of underwriting, knowing that it can be waived if needed, but may delay the process? *