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Please fill out the secure intake form below to apply for a merchant account

Business Details

Legal Business Name *

DBA (Doing Business As) *

Type of Ownership *

Select option

Corporate Phone *

Corporate Address *

City *

State *

Zip Code *

Physical Address Same as Corporate Address? *

Select option

If your physical address is different from your corporate address, please enter it here:

Corporate Email *

Description of Product Sold *

What type of business or product is sold? i.e. restaurant, auto shop, salón

Date Business Started *

Do you have a website?

Select option

If yes, what is your website URL?

Processing Details:

Typical High-End Ticket *

Please provide the highest amount you anticipate charging in a single transaction. Additional documentation required for high ticket sales including but not limited to business bank statements and past invoices.

Average Ticket Size *

How much is your average card sale?

Monthly Bank Card Volume *

Please provide the average total amount you process in card payments each month.

% Keyed (Card Not Present) *

What percentage of your card sales do are manually entered where the card is not present at the time of purchase (i.e., online or over the phone)?

% Card Swiped / EMV *

What percentage of your card sales do are swiped, inserted, or tapped via EMV?

If you have not processed credit cards yet, please enter estimated percentages (%) for each category. These can be approximate.

Sum of both these MUST BE EQUAL to 100. (La suma de ambos debe ser igual a 100)

Recent Monthly Processing Statement (Required for High Ticket Limits and Free Equipment) Est

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 6 Files )

Do You Accept EBT or Food Stamps?

Select option

FNS # (Required to accept EBT and/or food stamps)

If you accept food stamps and/or EBT payments, please enter your FNS number above.

Do you accept payment significantly in advance of delivering a product or performing a service? *

Select option

Future Delivery: Customers pay now but receive the product or service at a later date (such as deposits, pre-orders, hotel reservations, or contractor deposits). This does not include restaurants, takeout, or businesses that typically provide products or services immediately.

What percentage of the business is future delivery/deposits *

What percentage of a deposit is required?

How far out is the deposit placed before the product/service is rendered?

Do you sell Kava, Kratom, CBD, THC, or any products containing these ingredients? *

Yes

What is your refund policy?