Merchant Account
Application

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Merchant Account Application

All the form fields are required, if you are not sure just answer as close as you can.
Does your business currently accept credit cards?	Yes No
Are you currently in need of credit card processing equipment?	Yes No Not Sure
How much do you currently accept, or do you anticipate accepting, in monthly charges?	Under $5,000/month $5,000 - $10,000/month $10,000 - $20,000/month $20,000 - $40,000/month $40,000 - $100,000/month Over $100,000/month
What is, or do you anticipate, the average individual charge amount to be?	$1 - $50/transaction $50 - $100/transaction $100 - $1000/transaction $1000+/transaction
What is/are your most likely method(s) for accepting credit cards?	Manually swipe cards at a retail store or restaurant Through a website or online business By phone or through mail order Manually swipe cards at mobile business/trade show Other
Business Name
Type Of Products sold or services provided
State (in which company is located)
Zip Code
Contact Name
Contact Phone
Contact Email
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