Business Contact

First Name
Last Name

Corporate Name

Email Address

Address Type

Upload your Articles of Incorporation

Filename

Size

Process

Status

Add Files

Businesses that were established 1 year ago or less need to upload their Articles of Incorporation or Articles of Organization. Allowable file types: (pdf,doc,docx,txt,rtf,jpg,jpeg,png,gif) Max upload size: 5MB per file. Click Add Files to begin.

Business Entity

Principle #1

Responsible Party

Personal Guarantee

Ownership %

Residential Address

Street Address
Street Address 2
City	State
Zip Code	Country

Social Security Number

Home Phone

Principle #2

Responsible Party

Personal Guarantee

#2 - Ownership %

#2 - Residential Address

Street Address
Street Address 2
City	State
Zip Code	Country

#2 - Social Security Number

Required if person is Personal Guarantee

#2 - Home Phone

Area CodePhone Number

Principle #3

Responsible Party

Personal Guarantee

#3 - Ownership %

#3 - Residential Address

Street Address
Street Address 2
City	State
Zip Code	Country

#3 - Social Security Number

#3 - Home Phone

Area CodePhone Number

Principle #4

Responsible Party

Personal Guarantee

#4 - Ownership %

#4 - Residential Address

Street Address
Street Address 2
City	State
Zip Code	Country

#4 - Social Security Number

#4 - Home Phone

Area CodePhone Number

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Please enter your business transaction details below. If this is a new business then please estimate the values below based on your industry and financial projections.

Current/Previous Processor

Highest Transaction Amount

The largest transaction that you will process

Total Monthly Credit Card Sales

Visa/MC/AmEx/Disc/UnionPay Total Transactions

Industry Type

Service Delivered

When does the customer receive the product/service, how many days after payment (includes shipping)

Card Present %

Enter % of card present transactions, Omni-Commerce total must equal 100%

Internet %

Enter % of internet transactions, Omni-Commerce total must equal 100%

Please choose your equipment option

I want to purchase new POS/terminals for my storefront sales

I need to reprogram an existing credit card terminal

I process credit cards online and do not need equipment

Funding Type

Regular Funding - deposited into your bank 2 business days after settlement (no extra charge)

Next Day Funding - deposited into your bank the next business day after settlement ($7.50/mo)

Same Day Funding - deposited into your bank the same business day after AM settlement, usually for restaurants/bars open after midnight (10.00/mo)

Routing Number

The routing number will be found on the bottom of your checks. It is always nine digits long.

Let us know if you have any questions.

Merchant Account Application

Business Details

Owners/Officers

Business Environment

Processing Details

Bank Account Details

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