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Business/Corporate Name:
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Learn More
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DBA (Doing Business As) Name:
(enter "SAME" if the DBA matches
the Business/Corporate Name)
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Learn More
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Address Line 1:
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Learn More
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Address Line 2 (optional):
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City:
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State:
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Zip:
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Main Business Telephone Number:
(10 digits with dashes ex 800-555-1234)
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Same as Business Address
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Person we should contact for this Merchant Account:
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Alternate Telephone Number to reach the Contact Person:
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Best email address to reach this person of contact:
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Learn More
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Legal Organization:
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Learn More
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Federal Tax ID # (no dashes):
(OR your Social Security # will suffice if you are a sole proprietorship)
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Learn More
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Re-Enter Federal Tax ID # OR SS #:
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Business Website:
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Learn More
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Business Open Date(MM/DD/YYYY):
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Detailed Description of Products/Services Sold:
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Learn More
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Please choose the option that best describes your return policy:
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Other:
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Have you ever accepted credit cards for this exact business (answer NO if you have
accepted credit cards for a retail store but are now opening an online store)
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A Fulfillment House or Drop-Shipper is a company, other than your own, that ships products to your customers on your behalf
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If you do not use a Fulfillment House or Drop-Shipper, leave these 2 fields blank
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Primary Sales Method
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Learn More
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If you are using an ecommerce cart or if you are processing transactions through
another software product, please enter the following (if you are unsure of any fields,
please leave blank):
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Name of Software:
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Businesses:
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%
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Consumers:
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%
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Total:
Must equal 100%
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%
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Annual Visa/MasterCard/Discover Sales
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$
.00 Learn More
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If you have prior processing,
please use the data from your past merchant statements to populate this value. If
you are a new business or business channel, please make your best estimates. Certain
volume requirements may need more information.
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Average Visa/MasterCard/Discover Transaction
Amount:
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$
.00
Learn More
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Average tickets exceeding $350
may require additional information.
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Occasional High Visa/MasterCard/Discover
Transaction Amount:
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$
.00
Learn More
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Do you have a current American Express Merchant Account:
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My current American Express Merchant ID # is (must be 10 digits):
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I would like a NEW American Express merchant Account:*
*Some fees may be charged directly
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Sample Check (Click to expand):
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Bank Account Type
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Bank Routing Number:(must be 9 digits)
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Re-Enter Bank Routing Number:
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Bank Account Number:
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Re-Enter Bank Account Number:
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If you are unsure of the banking information that
you are going to use for your business deposits, please leave this information blank.
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Date in which you would like to start accepting credit cards through this merchant
account:
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Best time of day to contact you (check all that apply):
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Additional Information, Comments or Instructions regarding this merchant account:
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