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Name
Username*
First Name
Last Name
Contact Info
E-mail*
Phone*
About Yourself
Password*
Repeat Password*
Secret key*
Merchant Information
Merchant DBA Name*
Business/Industry Type*
Contact First Name*
Contact Last Name*
Merchant Contact Email*
Ownership Type*
Merchant Legal Information
Legal Address*
Legal City*
Legal State*
Legal Zip*
Federal Tax ID*
Date Incorporated*
State of Incorporation*
Customer Support*
Transaction information
Do You Currently Accept Credit Cards?*
- Yes
- No
Total Monthly Processing*
Average Ticket Value*
Highest Ticket Value*
Has Merchant Ever Had Processing Account Terminated?*
- Yes
- No
Has Merchant or Owners ever filed for bankruptcy?*
- Yes
- No
Transaction Types
Credit Card Swiped*
MOTO/Internet*
Business Details
Please describe in detail what you do and what you sell, including pricing*
Office Street*
Office City*
Office State*
Office Zip*
Principal Owner
First Name*
Last Name*
Title*
Ownership %*
Address*
City*
State*
Zip*
Phone Number*
Email*
Date of Birth*
SSN*
Nationality*
Financial information
Bank Account #/DDA*
Transit Routing #*
Bank Account Type*
Questionnaire
What % of your products/services will be sold/delivered in the following markets (total must equal 100%)?
North America*
Europe*
Other Markets*
What percentage do you sell to:
Business*
Consumers*
Briefly outline your return policy:
Briefly outline your return policy:*
When do you charge a customer?*
- Shipment/Completion of Service
- Order
Is a delivery receipt requested?*
- Yes
- No
What is the normal turnaround time from when you receive the order to the customer receiving the goods/services:*
Do you take advance deposits?(a percentage of the full value or a fixed part-payment paid in advance)*
- Yes
- No
Is your processing seasonal?*
- Yes
- No
Do you take payments for memberships, subscriptions, or packages?*
- Yes
- No
If Yes, please provide the usual breakdown of transactions (by % of total sales) and their respective price points.
If packages or memberships are sold, what is the average amount of time it takes a customer to use up their package?
Confirm that you are not a robot*
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Name

Contact Info

About Yourself

Merchant Information

Merchant Legal Information

Transaction information

Transaction Types

Business Details

Principal Owner

Financial information

Questionnaire

What % of your products/services will be sold/delivered in the following markets (total must equal 100%)?

What percentage do you sell to:

Briefly outline your return policy:

Document Upload