Merchant Account Pre-Application
Please complete the following merchant account application. Shortly after submitting the information, a representative will contact you with instructions regarding the activation of your merchant account
BUSINESS INFORMATION
Business Name:*
Business Address:*
Business City:*
Business State/Province:*
Business Zip/Postal Code:
Business Country:
Business Phone:*
Business URL:*
Type "none" if you are a retail merchant or you do not yet have a URL.
BUSINESS DETAILS
How does/will your business accept credit card payments? * (at least one)
Online
Telephone Orders
Retail Store or Restaurant
Mobile Location (job site, trade show, kiosk, etc.)
Please estimate your monthly sales amount.
$ *
Please estimate the average amount of each transaction.
$ *
PRINCIPLE BUSINESS OWNER INFORMATION
Owner First Name:*
Owner Last Name:*
Owner Address:
Owner City:
Owner State/Province:
Owner Zip/Postal Code:
Owner Country:
Owner Phone:*
Owner Email:*
* Denotes Required Field