Merchant Account Processing Application
First Name (Business Owner)
Last Name
Title
Business Ownership %
Personal Address
State
City
Zip Code
Year Moved In
Cell Phone Number
Social Security Number
Driver's License Number
Driver's License State
Date of Birth
Merchant Account Processing Application
Business / DBA Name
Business Legal Name
Business Typ
Date Business Established
Federal EIN
Business Phone #
Business Website
Is the Business Address same as the Business Owners Address? If not Enter Here Otherwise Leave It Blank
Is the Mailing Address same as the Business Owners Address? If not Enter Here Otherwise Leave It Blank
Briefly Describe Merchandise/Services Sold
Average Ticket Amount Anticipated Average Credit/Debit Card Sale Transaction Size
Average Monthly Volume Average Total Monthly Credit/Debit Card Sales Expected
Highest Ticket Amount* Largest Anticipated Credit/Debit Sale Transaction Size
Percent of
Percent of
Accepted Electronic Payment Methods (Check All That Apply)
If You have a Merchant Account to take Credit/Debit Cards
Current Merchant Account Processor
Current Merchant ID Number
Have any of the owners of the business ever had a bankcard relationship terminated?
Business Account Info
Business Bank Name
Bank Routing Number
Business Checking Acct. #
Documents Required For Prequalification
A copy of your Driver's License
Max. size: 512.0 MB
A copy of a voided check from your business account, or you may upload a letter from your bank with your business bank account number and the bank routing number.
Max. size: 512.0 MB
A copy of your business Articles of Organization or Articles of Incorporation, A copy of a voided check from your business account, or you may upload a letter from your bank with your business bank account number and the bank routing number.
Max. size: 512.0 MB
A copy of your business EIN letter with your Employer Identification Number. This is the SS-4 document your received from the IRS.
Max. size: 512.0 MB
A copy of your latest monthly processing statement from your merchant processor. Must show all transactions and fees paid (not just a Summary Report).
Max. size: 512.0 MB