Merchant Account Pre-Qualification
This Merchant Account Pre-Qualification form is not a binding contract for service. Information provided in this form allows our banking partners and merchant services providers to identify the most suitable electronic payment processing solution for the applicant. Information provided in this form is considered private and confidential in nature. Under no circumstances will your information will be sold to nor shared with any outside party that has no direct involvement in the provisioning of service.
Majority Owner Contact Information
Merchant Applicant Name *
Percentage of ownership? *
Legal Name of Company *
Merchant Applicant Role *
Have you been terminated from another processor? Are you on the Match List? *
If you have been terminated, please list which processor. And if you are on the match list, please provide the details about why.
Business E-mail Address *
Business Street Address *
Example: 3601 Walnut St,Denver, Colorado 80205, US (INCLUDE ADDRESS, CITY, STATE, ZIP, Country)
Type of Business Entity *
Merchant Payment Details
Describe ALL the products and services that you are offering to customers. *
Merchant Account Payment Type *
Check all that are applicable
Required
Business Website URL *
Which website builder do you use? *
Business Operation Questions
What is the average business bank account balance for the last three months? *
What are your annual gross sales (In US Dollars)? *
If you do not have data, please include your anticipated data by including the words in brackets [anticipated]. For Examples: $100,000 [anticipated]
What is your average monthly credit card processing volume (In US Dollars)? *
If you do not have data, please include your anticipated data by including the words in brackets [anticipated]. For Examples: $100,000 [anticipated]
How long has the company been in business? *
Customer Service Phone Number (w/ area code) *
Business Tax ID Number or SSN *
Bank Account Details: Account Number & Routing Number *
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