Skip to content
High Risk Solution
Adult
CBD
Cigar & Tobacco
Cryptocurrency
ECig & Vapor
Firearms & Ammo
Glassware
Marijuana
Multi-Level Marketing
Nutraceuticals
Online Gaming & Casino
Online Wine Clubs
Pharmacy
Students Loan Doc Prep
Telemed
Ticket Brokers
Travel
Solutions
Retail Merchant Services
Cash Discount Program
About Us
Contact Us
X
Apply Now
(877) 267-1555
Apply Now
Step
1
of
5
20%
1 - CONTACT INFORMATION:
Contact First Name:
(Required)
Contact Last Name:
(Required)
Contact Email:
(Required)
Contact Number:
(Required)
2 - MERCHANT BUSINESS INFORMATION:
Business Name:
(Required)
Legal Business Name
(Required)
Legal Address:
(Required)
Location Address:
(Required)
Legal same as location
Yes
Name of City:
(Required)
Legal Name of City:
(Required)
Name of State:
(Required)
Legal Name of State:
(Required)
Zip Code Number:
(Required)
Legal Number of Zip Code:
(Required)
Federal Tax ID#: (EIN)
(Required)
Date Incorporated:
Customer Service Email:
Entity Type:
(Required)
LLC
C CORP
S CORP
SOLE PROP
OTHER
Website:
Customer Service Phone No.
3 - MERCHANT BUSINESS INFORMATION:
Do You Currently Process Credit Card Payments?
(Required)
Yes
No
Total Monthly Processing:
Please enter a number greater than or equal to
1
.
Average Ticket Value:
Please enter a number greater than or equal to
1
.
Highest Ticket Value:
Please enter a number greater than or equal to
1
.
Do You Need Ability to Process Recurring Transactions?
(Required)
Yes
No
Has Merchant Ever Had Processing Account Terminated?
(Required)
Yes
No
Have Merchant or Owners Ever Filed for Bankruptcy?
(Required)
Yes
No
Type of Filed Bankruptcy
(Required)
Business
Personal
In Person Transaction:
(Required)
Internet/Phone
Website Platform:
Shopify
WordPress /WooCommerce
Big commerce
Other
Please Explain Other Website Platform
Describe Your Products/Services:
(Required)
Notes
4 - OWNER INFORMATION:
Owner 1
Title of Owner:
(Required)
First Name:
(Required)
Ownership %:
(Required)
Last Name:
(Required)
Phone Number:
(Required)
Address:
(Required)
City:
(Required)
State:
(Required)
Zip Code:
(Required)
Date of Birth:
(Required)
Driver’s License #:
Social Security Number:
(Required)
Driver’s License State:
Add Second Owner
All owners with more than 25% ownership need to be listed.
Add Additional Owner
Owner 2
Title of Owner:
(Required)
First Name:
(Required)
Ownership %:
(Required)
Last Name:
(Required)
Phone Number:
(Required)
Address:
(Required)
City:
(Required)
State:
(Required)
Zip Code:
(Required)
Date of Birth:
(Required)
Driver’s License #:
(Required)
Social Security Number:
(Required)
Driver’s License State:
(Required)
5 - BANK ACOUNT INFORMATION:
Bank Name for Deposits:
(Required)
Routing Number:
(Required)
Account Number:
(Required)
Bank Name for Withdrawals:
Routing Number:
Account Number:
Is it the same as deposit bank information?
Yes
Call Now Button