Pre-application for Merchant Accounts. One of our sales representatives will contact you within 24 hours.
PRE-APPLICATION MERCHANT FORM
*
indicates required fields
*
Type of Payment Method:
Credit Cards
Credit Cards & ACH
ACH Low Risk
ACH High Risk
POS Retail
*
Type of Account required:
International Account
American Account
Canadian Account
European Account
*
Name of Business:
*
Contact Name:
*
Contact Email:
*
Business Address:
*
State/Province:
*
Zip/Postal Code:
*
Daytime Phone:
Business Fax:
*
Legal Name of Business:
*
Principal Owner:
*
Type of Product or
Service Sold:
*
Age of Business:
*
What credit cards do
you currently accept?:
Visa & MasterCard
MasterCard
Visa
None
*
Who is your current
processor:
*
Indicate Monthly Visa and MasterCard volume:
*
What is your average
sales ticket:
*
What is your website url:
*
Which country are you
incoporated in?:
*
What percent is your monthly chargebacks?:
*
Direct or 3rd Party Account
(new business):
Direct Account
3rd Party
*
Comments: