merchant application form - Online Payments, eCommerce, Digital Advertising ,Shopping Carts, Point of Sale, POS, CRM , Gaming, CBD, WooCommerce

Merchant Application

Owner Title
Owner Equity Percentage
First Name*
Last Name*
Home Address
Suite/Apartment
City
State
Zip Code
Cell Telephone Number*
Date of Birth
Date Format: MM slash DD slash YYYY
SSN/Passport #
Business Name / DBA / Descriptor
Corporate / Legal Business Name
Business Type
Fed Tax ID
Merchandise/Services Sold
High Ticket Amount
Average Ticket Amount
Average Monthly Volume
Business Telephone Number
Business Fax Number
Business Website Address
Business Email Address*
Business Address
Suite/Apartment
City
State
Zip Code
Select Your Rates, Fees & Structure you are looking for (Call us at 888-395-9554 if you need assistance with rates)
Where should we send your money?
Routing Number
Account Number