Secure Online Application

Welcome To The Harbortouch Online Application

Takes about 5 mintutes to complete if you need any assistance call 888-246-0972
DBA Business Name
example: The Business Store
Legal Business Name
example: Business Enterprise, LLC
DBA Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Legal Business Address (if different then above address optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If multiple locations add them here along with the phone numbers
How many locations?
How old is your business?
Yrs = Years Mo. = Months
How long have you owned it?
Yrs = Years Mo. = Months
Business E-mail
Website (optional)
Business Phone Number

Area CodePhone Number
Business Fax Number (optional)

Area CodePhone Number
Federal ID
Fed ID is 9 digits or Social Security Number
Products or Services Sold?
What Is Your Business?
Trade Reference
Trade Reference Phone Number

Area CodePhone Number
Do You Currently Accept Credit Cards
Average Ticket (per sale)
Highest Ticket (per sale)
What Is Your Current or Expected Monthly Volume?
Just a close average is fine
Percentage Swiped
Put A Number In Even If 0
Percentage Key Entered
Put A Number In Even If 0
Percentage Online
Put A Number In Even If 0
Have You Ever Claimed Banruptcy?
If Yes Explain Briefly?
Have You Been Terminated By Another Payment Processor (TMF)?
Bank Information
Bank Name
Bank Phone Number

Area CodePhone Number
Routing Numbers
It is typically 9 digits long
Bank Account Numbers
Your checking or bank account numbers
Principle Information
Principles Name

First NameLast Name
Principles Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Social Security Number
Date Of Birth

MonthDayYear
Setup Information
What Payment Processing Solutions Are You Interested In?
What System or Setup Are You Interested In?

Other
How Many Systems Total?
For All Locations
Additional Comments
Should be Empty:

Welcome To The Harbortouch Online Application

Bank Information

Principle Information

Setup Information