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Please fill in your company information and we can typically have you up and running in as little as 24 hours!Business InfoLegal Business Name* DBA Name (if applicable) Years in Business* Referred by (if applicable) Business Physical Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time at this location* Full Name of Business Contact Person* Business Contact Title* Business Email* Business Phone Number*Business Website* Tax ID* Corp. Type*> Limited Liability Company (LLC)> S Corporation> Corporation> Partnership> Sole ProprietorshipCorp. State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBusiness Bank* Routing Number* Ownership InfoPrincipal Owner Name* % of Ownership* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Any Additional Owners?* Yes No Principal Owner Name* % of Ownership* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Any Additional Owners?* Yes No Principal Owner Name* % of Ownership* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Any Additional Owners?* Yes No Principal Owner Name* % of Ownership* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Processing InfoHow many transactions (debits) will you process per month?*> 1-25> 26-99> 100-499> 500+What is the average dollar amount per transaction?*> $1-$99> $100-$499> $500-$999> $1,000-$4,999> $5,000+Highest amount you receive on any single transaction* Estimated monthly dollar amount of transactions?* Do you have Recurring Payments?* Yes No What % of Monthly Volume is Recurring?*> 1%-10%> 11%-25%> 26%-49%> 50%+What is your refund policy?* What is the average dollar amount per refund?* What is your estimated monthly dollars refunded?* Describe how you market your goods or services* Do you require website integration?* Yes No What type of website integration do you require?* WooCommerce Shopify Magento Debt Pay Pro Rest API (Used for CRMs, Websites, etc...) Other Select all types of goods or services provided by your business.Animal ServicesAudio/Visual ServicesAuto ServicesBeauty ProductsBilling ServicesBusiness ConsultingBusiness SoftwareClothing/Apparel Collection AgencyConstructionCredit ConsultingDivorce AssistanceDocument PreperationEducational ServicesEquipment SalesFinancial Consulting Financial ServicesFitnessFood ServicesFurniture SalesGold & SilverHealth/Wellness ServicesIT Services/SoftwareKratomLegal ServicesMarketing ServicesMedical Equip/SupplyMerchant ServicesMoving CompanyOnline EntertainmentOnline ServicesPacking/Shipping SuppliesPeptidesReal Estate/Property ManagementSARMSSEO ConsultingSmoking Accessories Sport ServicesSupplements Tax ServicesTravel ServicesOther Add RemoveDocument UploadAll documents uploaded will be placed in a secure/encrypted DropBoxCopy of Owners Driver’s License or Passport* Drop files here or Select files Max. file size: 50 MB. Bank Document showing business name* Drop files here or Select files Max. file size: 50 MB. Articles of Incorporation Drop files here or Select files Max. file size: 50 MB. Copy of EIN, SS4 or last years tax filling Drop files here or Select files Max. file size: 50 MB. *Additional documents may be requiredEnter an email address where a copy of the form will be sent.* Prove you're not a robot. What is 11+6? *You will be redirected to the terms and conditions signing page after pressing submit. Please read the entire document before signing.
