Apply for Payment Processing

Screening Questions

Please answer these preliminary questions to proceed.

These questions help us determine your eligibility for payment processing services. All information is kept confidential.

Are you a US Citizen? *

Yes

Do you have an ITIN? *

Yes

Do you have US Physical Presence? *

Yes

Working with a chargeback provider? *

Yes

Chargeback Provider Details

Provider Name

Provider Website

Provider Contact Email

Pre-Application

Tell us about your business and principal owner.

Business Information

Legal Business Name *

DBA Name

Legal Address *

City *

State *

Zip Code *

DBA Address

DBA City

DBA State

DBA Zip

Business Phone # *

Customer Service Phone #

Fax Number

Contact Email *

Contact Name *

Federal Tax ID (EIN) *

Website URL

Number of Locations

Average Ticket *

Monthly Volume *

Products/Services Being Sold *

% Keyed

% Swiped

Equipment/Software Used

Type of Business *

Business Start Date *

Sale Method *

Store Front

MOTO

E-Commerce

Principal Information

First Name *

Last Name *

Middle Initial

Home Address *

City *

State *

Zip *

Home Phone #

Principal Email *

Date of Birth *

Driver's License or Passport # *

Ownership % *

Controlling Individual *

Yes

Country of Origin *

Bank Information

Provide your business banking details for settlements.

Secure Bank Details

Your information is protected with bank-level security

256-bit SSL

PCI Compliant

Name on Bank Account *

Bank Name *

Bank Phone #

Routing/Transit # *

Account # *

Identity Verification

Required for compliance and fraud prevention

Social Security # *

Document Upload

Upload the required documents to complete your application.

Secure Document Vault

Files are encrypted during transfer and storage

End-to-End Encrypted

3 Months Bank Statements

PDF or images • Max 10MB each

3 Months Processing History

PDF or images • Max 10MB each

ID or Passport

Clear photo or scan • Max 10MB

Application Submitted!