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Home
About Us
Solutions
Payment Processing
Point-of-Sale (POS) Systems
E-Commerce Solutions
Merchant Services
Business Solutions / Value-Add
Industries Served
Blog
Contact
Referrals
Home
Referrals
Business Information
Doing Business As/DBA: (Business Name In Google) *
Legal Business Name: (As shown on Income Tax Return) *
Owner's Name *
Owner's Phone Number *
Physical Address *
Mailing Address *
Business Phone *
Email *
Website
Payments Accepted Through Website
Yes
No
Time Zone *
Merchant Location *
Store Front
Office Building
Warehouse
Residence
Other
Merchant Location *
Lease
Own
Merchant has required business licenses? *
Yes
No
Tax ID EIN *
LLC
S Corporation
C Corporation
501c3
Sole Proprietor
Business Start Date: (EIN Issue Date) *
Ownership Type *
Public
Private
Merchant Account Information
Transaction Volume Information: (Data will be used to set the volume limits for the account. Please make sure it is accurate.)
Average Monthly Volume *
Average Transaction Amount *
Est. High Single Transaction *
Processing Options *
Cash Discount (passing the processing fees to customers who choose to pay with cards)
Traditional Processing (merchants pay a fee for each card transaction)
Estimate what % of your transactions are... (All transactions % must add to 100%)
Card Swipe *
Manually Keyed *
Internet *
Phone/Mail Order *
What type of payments to be accepted: (Additional cost are involved for ACH, eChecks, Gift Cards, and EBT) *
Visa
Mastercard
AMEX
Discover
Pin Debit
Voyager
ACH
eChecks
Gift Cards
EBT
WEX
Other
Number of ACH Transactions per Month
Max Monthly ACH Transactions Volume
Max Daily ACH Volume
Max Daily No. of ACH Transactions
ACH Returns/Month
Do you want to automatically batch out *
Yes
No
When is the card charged? *
In Advance
When Service/Product is Shipped
Refund Policy *
Exchange Only
No Refund/Exchange
Under 30 Days
30+ Days
Products/Services Delivered in *
0-7 Days
8-14 Days
15-30 Days
Over 30 Days
Referring Partner *
Submit Referral
