Business Merchant Account Information

Merchant Account Information - Business

Please fill out this form to apply for a merchant account. Once submitted, we will complete the application and email it to you for signatures.
Business Information
Legal Name of Business:*
Doing Business As:*
Business Address 1:*
Business Address 2:
City:*
State:*
Zip Code:*
Billing Address (if Different than Business Address):
City:
State:
Zip Code:
Business Phone*

Area CodePhone Number
Business Fax

Area CodePhone Number
Business Website*
Business Contact*

PrefixFirst NameLast Name
Business Contact Title
Business Contact Phone*

Area CodePhone Number
Business Contact E-Mail*
Organization Type*
Description of Business*
State filed if applicable*
Federal Tax ID #*

Business Operation
Type of Business*
Business Start Date*

MonthDayYear
# of Locations*
# of Employees:*
# of Registers/Terminals
Own or Lease Premises:*

OwnLease/Rent
If Lease/Rent, Landlord Name and Telephone:*
Trade Reference:*
Address:*
City:*
State:*
Zip Code:*
Contact Name:*
Contact Phone:*

Area CodePhone Number

Bank and Card Information
Bank Name*
Bank Address*
City:*
State:*
Zip Code:*
Contact:*
Phone:*

Area CodePhone Number
Routing Number (9 digits)*
Account Number*
Account Type*

CheckingSavings
What cards would you like to accept?*

Visa/MastercardDiscoverAmerican Express
Existing AMEX #
Gross Sales Volume:*
Yearly total of Cash/Credit/check
Visa/MC Volume:*
Yearly average volume
Discover Volume:*
Yearly average volume
AMEX Volume:*
Yearly average volume
Average Sale/Ticket:*
Individual sales/tickets
Highest Sale/Ticket:*
Highest possible Sale/Ticket
Submission Instructions

Two additional items will be needed to complete the application:1. A copy of a voided check for the account listed above that the funds will deposit into. If this is a deposit only account then a bank letter will be needed (a simple statement on bank letterhead of your account number and routing number signed by a bank official)2. IRS verification. Any IRS document that list the legal name of the school, address and EIN/Federal Tax ID#.
Should be Empty: