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Merchant Account Pre-Application
Apply Now for Free and with No Obligation
Please fill out this short application as completely as possible.  Someone from our merchant account
department will contact you as soon as they receive your request.

If there is any information that you don't have available or a question that you don't understand, just leave
it blank and we will help you when we contact you.

For your privacy and security, this page is encrypted. Your information will be kept completely confidential
and will not be shared with anyone other than is absolutely necessary to process your application.  If you
still have questions or concerns about privacy, please call us at 800-777-8981 and we can mail you an
application to fill out.

We do not accept adult related business, or businesses outside of the U.S.
General Company Information
* Required Field
*
 Legal Business Name:
DBA Name (if applicable):
*
 Type of Business:
Street Address:
City:
 State:
 Zipcode:
Date Business Started:
Length of Current
Ownership:
Contact Person:
*
*
Contact Phone#:
Fax#:
*
 Email Address:
Restaurant
Retail
 Mail/Phone Orders
Sales Sources?
Products and/or
Services Being Sold:
Personal Information on Owner/Officer
*
 Owner/Officer Name:
*
 Title:
Home Address:
City:
 State:
 Zipcode:
Home Phone#:
Processing Information
Do you currently accept bank cards?    Yes
 No
If so, which ones?
(Use shift key to select
more than one card type)
Do you have credit card equipment?    Yes
 No
I need to press '9' to get an outside line on my telephone
I have a phone jack and electrical plug within 6ft of the
location where I want to have my credit card terminal
Anticipated average sales ticket amount:
Comment or Questions:
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Merchant Account