Merchant Application

Business Contact Information

Please complete this form to apply for merchant services.

Business Name*

Street Address*

City*

State*

Zipcode*

Phone*

Website or Website Domain*

Business Type and Description

Business Type*

Legal Business Name*

Years in Business*

EIN (Tax ID)*

Describe your Business*

Average Payment*

Sells Physical Products*

How do you process payments now?*

You, responsible party.

Submit this application only if you have the authority to do so. If you are not the responsible party, provide the responsible party's information. Please be aware that the responsible party must verify and complete the final application.

Your Legal Name*

Your Company Email Address*

Your Title*

Your Date of Birth*

Bank Account Information

Bank Name*

Routing Number*

Account Number*

Submission

By my signature below, I certify that I have the authority to submit this form for my company and hereby agree to the terms and conditions for this service.

Type Your Name Here*

Signature Block*

Thank you for submitting your application!

We will get the process started right away. You will soon receive an email with a link to complete the application. Please allow 24 hours. Supporting documentation will be required, including (1) a copy of a voided business check or bank letter and (2) such other documentation as will be needed. Please have that ready for upload.