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Merchant Pre-Application Form
Please fill out the form below!
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Legal Business Name
*
DBA Name (Doing business As)
*
Business Address
*
Incorporation State
*
Incorporation Date
*
Entity Employer Identification Number (EIN)
*
Website URL Applying for processing
*
Type of Goods or Services offered
*
Test Username / Password to Member area (if applicable)
Principal: Full Name
*
Principal Physical Address
*
Principal Phone Number
*
Principal Email Address
*
Principal Social Security #
*
Has entity processed before?
*
Yes
No
Current Monthly Processing Volume (If applicable)
*
Average Transaction Size
*
Estimated # of Monthly Transactions
*
Desired Monthly Transaction Volume ($)
*
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