Merchant Account Application

Apply for a Merchant Account Today!

Use the form below to apply for a merchant account in minutes

Once your information has been received, an agent will reach out to review your information and email a DocuSign for signatures.

Business DBA(Required)

DBA or Doing Business As name ex: Example Solutions

Business Legal Name(Required)

List your tax filing name ex: Example 1 LLC

Entity Type

LLC

Private Corporation

Individual / Sole Proprietor

Partnership

Tax Exempt

Gorvernemt

Non-Profit Organization

Public Corporation

Email for Login(Required)

List the email receiving dashboard login and application for signature

Business Formation Date(Required)

Business Phone Number(Required)

Website URL

Required on all E-Commerce Accounts

EIN Number(Required)

Tax ID Number

Industry MCC Code

Cell Phone Number(Required)

This number will receive text alerts for account login

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Owner Information

Owner Name(Required)

First Last

Phone

SSN

Date

Owner Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title(Required)

Ownership Percentage

Additional Owner Information

Additional Owner Name

First Last

Cell Phone

SSN

Date

Additional Owner Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title

Ownership Percentage

Deposit Banking and Processing

Deposit Routing Number(Required)

Deposit Bank Account Number(Required)

Where Funds will be Deposited

Account Type(Required)

Checking

Savings

Bank Name(Required)

Withdraw Banking and Processing

Withdraw Routing Number

Withdraw Bank Account Number

Where Fees will be Debited

Account Type

Checking

Savings

Bank Name

Processing Volume(Required)

Average Monthly card volume

Average Ticket Amount(Required)

The average transaction amount of a customer

Product Service Window

Product / Service Delivery Window(Required)

Mode Of Transaction

List the Percentage of Transaction Types your business accepts: Card Present = In Person Transactions Moto = Transactions done over the Phone Eccomerce = Transactions via Website All 3 Values must equal 100 - Enter 0 if Not Applicable

Card Present(Required)

MOTO(Required)

ECOM(Required)

Must equal 100% - list all type of transactions your business accepts

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