Online Pre-Application

Business Information

Type of Ownership *

Legal Name *

*If sole proprietor enter your first and last name only, otherwise enter legal company name here

Legal Address *

Street Address

City

State

Zip Code

DBA Name*

*(Doing Business As) This will appear on cardholder's statements as the charge

DBA Address *

Street Address

City

State

Zip Code

Premise Type

Length at Location *

Years

Months

Business Phone *

*Please enter numbers only no spaces or dashes

Tax ID/EIN *

*Please enter numbers only no spaces or dashes

Email address *

Type of Business *

*What type of product or service do you offer?

Length of Ownership

Years

Months

Website Link

Personal Information

Full name *

First Name

Last Name

Home Address *

Street Address

City

State

Zip Code

Time at current residence *

Years

Months

Social security *

*Please enter numbers only no spaces or dashes

Drivers License *

Number

State

Date of Birth *

MM/DD/YYYY

Personal Phone *

*Please enter numbers only no spaces or dashes

Personal Email *

Second signer

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Full name

First Name

Last Name

Home Address

Street Address

City

State

Zip Code

Time at current residence

Years

Months

Social security

*Please enter numbers only no spaces or dashes

Drivers License

Number

State

Date of Birth

MM/DD/YYYY

Personal Phone

*Please enter numbers only no spaces or dashes

Personal Email

Click to add second Signer

Bank Information

Bank Name *

Routing Number *

*Please enter numbers only no spaces or dashes

Account Number *

*Please enter numbers only no spaces or dashes

Credit Card Processing

Currently processing? *

Yes No

Need Check Processing? *

Yes No

How are you taking cards? *

in person swipe online over the phone

Max. monthly sales (USD) *

* Please enter numbers only no commas, dollar signs or spaces

Average/Highest Tickets *

Average *Average transaction size in USD

Highest *Highest average transaction size in USD

Documents

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We will not sell or distribute this information to any third parties. This information will be used to submit to the specified bank for the sole purpose of obtaining a merchant account. Your information will not be stored.