Merchant Processing Application
Please complete the fields below to apply for credit card processing
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Business Legal Name *
Business DBA Name
Business Address *
City *
State *
Zip Code *
Business Phone *
Business Contact Name *
Entity Type *
Business Email Address *
Date Business Was Established *
MM
/
DD
/
YYYY
Business Tax ID *
Business Location *
Required
Ownership Percentage *
Title *
First Name *
Last Name *
DOB *
MM
/
DD
/
YYYY
Residential Address *
City *
State *
Zip Code *
Personal Phone Number *
SSN (social security number) *
Additional Ownership percentage (If applicable)
Additional Owner First Name
Additional Owner Last Name
Additional Owner DOB
MM
/
DD
/
YYYY
Additional Owner Residential Address
Additional Owner City
Additional Owner State
Additional Owner Zip Code
Additional Owner Phone Number
Additional Owner SSN
Business Annual Expected CC Revenue *
Average Transaction Size *
Highest Ticket Size *
Frequency of Highest Ticket Per year *
Total Monthly Sales *
Customer Service Phone Number *
Contact Us Email *
Company Website
Industry *
Percentage of CC Sales In Person, By Phone, or By Internet ( Total must be 100%) *
How many days from transaction to delivery? *
Deposit Bank Name *
Routing # *
Account # *
Equipment needed? *
Email address to send contract agreement *
Submit
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