CBD Merchant Account Pre-App
Use this form to start the process of getting a US Based CBD Approved Merchant account with 3.95% rate, no reserve, and next day funding.

Here are some of the benefits of this CBD merchant program:
- Discount rate: 3.95% + $0.35 per transaction (Includes interchange and all 4 major cards)
- Monthly fee: $39.99 per month (includes customer service, gateway fee, PCI Compliance fee
- 100% US Based Solution
- Authorize.net, USAePay, or NMI gateways are all available
- Annual fee: Only $95 per year
- NO reserve -NO contract -NO cancellation fees-
- Next day funding

Email address *
Contact Phone Number *
Your answer
Best contact person: *
Your answer
1. Business Information
Legal name (Include LLC or INC) and DBA:
Your answer
Business mailing address:
Your answer
Years in Business:
Your answer
EIN / Federal tax ID number:
Your answer
Best customer service number:
Your answer
Best business email for customers:
Your answer
Website/URL for your business:
Your answer
2. Parameters
Anticipated average sale amount:
Your answer
Anticipated highest sale amount (at one-time on one card):
Your answer
Anticipated monthly volume in just card sales:
Your answer
3. Signor Information
Legal first and last name:
Your answer
Title and ownership %:
Your answer
Social security number:
(for an identity verification - Please note, you can add this to the final application later if you feel more comfortable)
Your answer
Date of birth:
MM
/
DD
/
YYYY
Driver's license #, exp date, and state it's issued in:
Your answer
Residential address (on your DL):
Your answer
4. Banking Information (where funds should be deposited)
Bank name:
Your answer
Routing number (9 digits):
Your answer
Account number:
Your answer
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