Online Application

Create Your Account

ACCOUNT TYPE

Primary Owner

FIRST NAME First Name is Required

MIDDLE NAME

LAST NAME Last Name is Required

SOCIAL SECURITY NUMBER(SSN) Social Security Number is Required

DATE OF BIRTH Date of Birth is Required

EMAIL EMail is Required

PHONE 10 Digit Phone is Required

BUSINESS TITLE Business Title is Required

OWNERSHIP % Ownership Percentage is Required

OWNER ROLE TYPE

ADDRESS Address is Required

CITY City is Required

STATE State is Required

ZIP Zip Code is Required

Country

Tell Us About Your Business

DBA NAME DBA Name is Required

STATE OF INCORPORATION State is Required

DATE INCORPORATED (MM-DD-YYYY) Incorporation Date is Required

MERCHANT INDUSTRY CODE Industry Type is Required

INDUSTRY TYPE Industry Type is Required

ENVIRONMENT Environment Type is Required

BUSINESS LOCATION TYPE

CHAIN OR SINGLE LOCATION

BUSINESS DESCRIPTION Business Description is Required

AVERAGE TICKET

LARGE TICKET

MONTHLY MAXIMUM

ANNUAL REVENUE Annual Revenue is Required

WEBSITE Website is Required

Copy From Above

ADDRESS Address is Required

CITY City is Required

STATE State is Required

ZIP ZIP Code is Required

Years at Address

Tell us where to send your money

UPLOAD YOUR DOCUMENTS

Basic Fees

CC Processing Fee Interchange

3.25% + $0.15

I Agree to the Terms and Conditions and Fees, I also agree that your electronic signature has the same legal validity and effect as your handwritten signature on the document.

X Sign Here Clear

Submit

MERCHANT SIGN UP FORM

Primary Owner

UPLOAD YOUR DOCUMENTS