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subscription/basic

Application

1. Business Information

Owner First Name*

Owner Last Name*

Owner Email Address*

Business Phone:*

Doing Business As Name (DBA):*

The name your customers will see on their credit card statements.

Legal Business Name:*

Company Ownership:*

Business Address:*

Business City*

Business State*

Business Zip*

Business Website

2. Personal Information

Owner Address:*

Owner City:*

Owner State:*

Owner Zip*

Owner Phone:*

Owner Title:*

Owner Date of Birth:*

Ownership Percentage:*

Ownership Percentage: *

100%

Other

Other Percentage*

3. Processing Information

Description of Business:*

Description of Business: *

Storefront

Office

Mobile

E-Commerce

Date Business Started:*

Number of Locations

What product(s) or service(s) will you be selling?*

How much will your average credit card transaction be?*

Example: $20, $100, $500

How much will your highest credit card sale be?*

What is your Return Policy, Cancellation or Refund Policy?

Do you currently accept debit/credit card?*

Do you currently accept debit/credit card? *

Yes

No

Select Files

Accepted file types: jpg, jpeg, gif, png, pdf.

How does the customer purchase or order products?

What is the delivery time to the customer?

How much do you expect to process in total credit card volume each

month?*

Example: $2,000, $5,000, $20,000

Bank Name:*

Bank Routing Number*

Routing is always 9 digits

Bank Account Number*

Account numbers vary in length

Voided Check*