APPLY FOR YOUR ACCOUNT NOW

apply for your merchant account now

Thank you for your interest in becoming one of our merchant partners.

Below is a preliminary application that we require our potential merchant partners to complete.

Before you complete this application please note that you will be required to provide the following information on the documents that we will send to you very soon:

-Your Business Tax ID Number
-The Social Security Number of the owner(s)
-The business address and the home address of the owner(s)

Also, you will be required to submit a VOIDED CHECK in order for us to deposit your funds into your bank account.

Please proceed in filling out the below application if you are comfortable in providing this information to us.

preliminary application

LEGAL BUSINESS NAME

DBA NAME (if different from legal name)

BUSINESS OWNER#1 NAME

BUSINESS OWNER#2 NAME
(if applicable)

BUSINESS STREET ADDRESS

CITY

STATE

ZIP CODE

BUSINESS DESCRIPTION

NUMBER OF LOCATIONS

BUSINESS TELEPHONE#

BUSINESS FAX#

BUSINESS EMAIL

YEARS IN BUSINESS

CELL PHONE #

DO YOU HAVE INTERNET ACCESS?

HOW IS YOUR BUSINESS OWNERSHIP ORGANIZED? (please select one box)

IF YOUR BUSINESS IS A CORPORATION, WHAT STATE AND YEAR WAS YOUR BUSINESS INCORPORATED?

STATE

YEAR