Payment Processing Solutions

Payment Methods

Sales Agent Referral

The name of the sales agent who is providing the referral.

Requested Payment Methods

Please select the payment method(s) you are applying for.

ACH

RTP

XRTP

IAT

EPX

Credit Card

UPI

Corporate Information

Corporate/Legal Name

Business Name (DBA or Trade Name)

Business Type

Other Business Type Description

Business Address

Address (No P.O. Boxes)

City

State/Province

ZIP/Postal

Country

Telephone

Cellphone

Please check this box if you mailing address differs from your billing address.

Mailing Address

Address (No P.O. Boxes)

City

State/Province

ZIP/Postal

Country

Length of Time in Business

Incorporation Date

Incorporation State

Incorporation Country

Federal Tax/VAT ID

Company Registration Number

Please check this box if you require a license for your services.

Licensing Details

Type of License held. (Example - Regulatory License, etc.)

Licensing Jurisdiction

License Number

How Did You Hear About Us?

Contact Information

Primary Contact Person

Email Address Primary (Login) Email Address

Confirm Email Address

First Name

Last Name

Phone Number

Skype ID

Tech Support Contact

First Name

Last Name

Phone Number

Skype ID

Customer Service Contact

First Name

Last Name

Phone Number

Skype ID

Accounting Contact Details

First Name

Last Name

Phone Number

Skype

Owner(s) Information

Owner Details

Title

Owner First Name

Owner Last Name

Ownership %

Address (No P.O. Boxes)

City

State/Province

Zip/Postal

Country

Date of Birth

Phone

Passport Number

Passport Issued Country

SSN / EIN

Website(s) Information

Website

Website Address

Business Profile

Primary Product/Service?

Describe your Primary Product/Service

Future Delivery of Goods

Do you Maintain an Inventory?

What is your average future delivery time? (In Days.)

Total Monthly Amount

Total Monthly Count

Minimum Transaction Amount

Maximum Transaction Amount

Average Transaction Amount

Transaction Distribution Percentage

USA

Canada

Europe

Asian Pacific

Latin America

Other

Marketing/Sales

Please Describe How you Offer your Services/Products

Marketing

% of Internet Marketing

% of Telephone Marketing

Sales

% of Internet Sales

% of Telephone Sales

Previous Processing

Are you currently processing with another provider?

Processor's company name

How long have your been processing with this company?

Have you ever been terminated by any processors?

The reason for your temination

Reason for leaving this processor

Reason for applying with us

Please list the services you had with this processor

Settlement Information

Bank Account Holder Information

Name

Address

City

State/Province

Zip/Postal

Country

Account Number

ABA/Routing Number

Sortcode

IBAN Number

Swift / BIC (If Applicable)

IRC (If Applicable)

Bank Information

Bank Name

Address

City

State/Province

Zip/Postal

Country

Bank Phone Number

Required Documents

* The ability to add multiple documents of a single type is available. In order to do so hold ctrl and used the left mouse button to select all relevant documents for the selected type from the document selection screen.

Certificate of Incorporation

Valid Government Issued Identification

Most recent office lease (Or utility bill within last 3 months)

Terms & Conditions for Products and Services

Refund & Cancellation Policy

Certificate of Good Standing/Licensing

Taxpayer ID (EIN)

6 Months Processing Statements (Most Recent)

6 Months Banking Statements (Most Recent)

IF MERCHANT SELLS TANGIBLES: copy of fulfillment and supplier agreement required

Note: We may require additional documentation for applications. Such as corporate financial tax return, etc.

By checking this box, I acknowledge that I have read the disclaimer in all its entirety and am ready to submit my application to the team for underwriting. I warrant that all information and documents provided in this application are accurate and that I have not misrepresented or falsified any information.

By checking this box, I acknowledge that my application is not complete however we will provide me with portal access to complete it at a later time once I have gathered all the necessary information and documentation.

Merchant Application

Payment Methods

Sales Agent Referral

Requested Payment Methods

Corporate Information

Corporate Information

Business Address

Mailing Address

Licensing Details

Contact Information

Primary Contact Person

Tech Support Contact

Customer Service Contact

Accounting Contact Details

Owner(s) Information

Owner(s) Information

Owner Details

Website(s) Information

Website(s) Information

Website

Business Profile

Business Profile

Transaction Distribution Percentage

Marketing/Sales

Marketing

Sales

Previous Processing

Settlement Information

Settlement Information

Bank Account Holder Information

Bank Information

Required Documents

Required Documents