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Merchant Card Services Application Form

 


Merchant Accounts

Main Site

For each named party:

  1. color scan of valid Passport
    -- be sure to circle your name and address on the following --
  2. color scan of valid Driver's License or other Photo ID (even a credit card)
  3. scan of paper Telephone Bill (home) or other Utility bill (doesn't have to show your name, just your address)
  4. Bank or other Statement showing your name and address (if your utility bill doesn't show your name)

 

We do not accept applications from the following countries.
We do not merchants dealing in the following trades.

  • Personal Information

    Business Name
    Business ID Business Registration ID
    Business Country Country Business is Registered in
    Owner / Officer
    SSI/ID Number Social Security Number or ID Number
    Business Address
    City / State / Zip / /
    Name of Current Banking Institution
    Mailing Address
    City / State / Zip / /
    Phone Day
    Night
    Fax
    Email

    Business Information

    Business Type
    Business Location
    Nature of Business
    Marketing Method
    Years in Business
    Web Site Address
    Products Sold
    Card Processing for
    Internet
    Store Front
    Phone / Mail order

    Processing Information

    Do you have a US Business Address? YES NO
    Do you have a US Corporation with EIN? YES NO
    Do you have a US Bank Account YES NO
    If your answer is Yes, please provide the following info. Bank Name
    ABN / Routing Number
    Business Account Name
    Account Number
    Do you currently accept cards? YES NO
    Current/previous card processor
    Estimated average credit card transaction
    Estimated maximum credit card transaction
    Estimated monthly card volume

    Credit Information

    Please rate your personal credit history
    Any bankruptcies in the last 3 years? YES NO
    Comments

     

           

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