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Get Started

Below you'll find our merchant information form. Please fill it out with all the required information. A representative will then contact you shortly to complete the merchant application process.

Your business must be located in the USA.

Business Information

Legal Business Name

Doing Business As Name (DBA)

Business Email

Business Phone

Company Website

Physical Business Address (No PO Boxes)

Physical Business Address Line 2

City

State

Zip code

Type of Business

Principal Contact First Name

Principal Contact Last Name

Principal Contact Email

Principal Contact Phone

Mailing Address (If different from business address)

Mailing Address Line 2

City

State

Zip code

Monthly Dollar Volume

Average Ticket Size

Number of employees

Date Your Business Started

Do you already own any credit card equipment? If so, describe what you have.

Owner/Principal Information

Owner/Principal First Name

Owner/Principal Contact Email

Owner/Principal Contact Phone

Home Address

Home Address Line 2

City

Region/State/Province

Postal / Zip code

Ownership %

Ownership/Principal Title

Additional Comments

The information you provide on this form will be kept strictly confidential and will only be used to prepare the appropriate merchant account documents that will be sent to you for your approval via a secure link.