Filling in the form below will provide the data points needed to create a map leading us to the processors that are most likely to approve your business type as well as which of them can offer you the most reasonable cost.

Within 24 hours of submitting your information, we'll email you a completed application and full schedule of fees representing the processor that is the best fit so that you can review the rates and terms before signing and applying.

Until you physically sign an application and send it back, you are not applying to any of our processors and your credit will NOT be pulled.

legal business name

IF YOU ARE A SOLE PROPRIETORSHIP THE LEGAL NAME OF YOUR BUSINESS IS YOUR FIRST AND LAST NAME

dba name

WHAT NAME ARE YOU DOING BUSINESS AS IF DIFFERENT THAN THE LEGAL BUSINESS NAME?

legal business address

MUST PROVIDE FULL STREET, CITY, STATE AND ZIP

legal phone #

(###)

###

####

business email

website address/url

http://

description of goods/services being sold

DESCRIBE WHAT YOU SELL

years in business

HOW LONG HAS YOUR LEGAL BUSINESS BEEN ESTABLISHED ROUGHLY?

# of business locations

IF YOU ARE HOME BASED JUST PUT "1"

contact name

WHO IS THE BEST POINT OF CONTACT IF NOT THE SIGNER OF THE APPLICATION?

First Name

Last Name

name of current processor

WHAT IS THE NAME OF YOUR CURRENT OR LAST PROCESSOR IF ANY?

which processors have you applied to so far?

THIS TELLS US WHICH PROCESSORS NOT TO WASTE TIME WITH WHICH SAVES YOU TIME AND SPEEDS UP THE PROCESS

average transaction size

highest transaction size

estimated monthly volume

% of sales swiped

% of sales keyed in

% of sales E-commerce/Website

% of international sales

WHAT % OF YOUR SALES DO YOU GUESS WILL COME FROM CUSTOMERS OUTSIDE OF THE US?

refund policy

EXAMPLE: 30 DAY REFUND, NO REFUND, EXCHANGE ONLY..

signer's name

First Name

Last Name

title

date of birth

% of ownership

residential address

MUST PROVIDE FULL STREET, CITY, STATE AND ZIP

signer's direct phone #

(###)

###

####

today's date