Merchant Account Application

First Name

Last Name

Legal Company Name

Business Street Address

City

State

Zip Code

Business Phone

Business Fax

Cell Phone

Email Address

Business Tax ID

Year Company Established?

Your Company Position

Is this your first merchant account?

YESNo

What is your anticipated average ticket size transaction?
Error on the lower side as this will have an affect on your discount rate and risk placement.

What is your anticipated monthly transactional volume?
This is the number of monthly transactions multiplied by your average ticket size value. Again, error on the lower side for a better rate.

Describe the products you will be selling
i.e. Computer Hardware, Clothing, Service, etc.

What method of transactions do you want to take?
Feel free to select multiple options.

InternetWirelessTerminal

What card brands do you want to accept?

VisaMasterCardAmerican ExpressDiscoverJCB

Do you currently have a payment gateway?

YesNo

If you do have a payment gateway, who is it with?
We require this for compatibility reasons.

Do you want to take advantage of 3D Secure technology to reduce fraud?
This is the technology that protects merchants from charge backs due to fraudulent credit cards being submitted through their web site. It enables the customer to validate their card with the pin number.

YesNo

Is your web site contruction done?

YesNo

What is the web url to your web site?
Internet merchants please fill this in.

What software platform is your web store running?
Internet merchants enter: Magento, OScommerce, XCart, CreLoaded, etc.

or Reset

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Merchant Account Pre-Qualification Request

Merchant Accounts

Payment Gateways

3D Secure

Company

Business Solutions

Business Resources

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