Owner Title
CEO
Manager
Owner
Partner
President
Vice President
*
Owner Equity Percentage
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First Name
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Last Name
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Home Address
Suite/Apartment
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City
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State
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Zip Code
*
Country
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Cell Telephone Number
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Personal Email Address
*
Date of Birth
*
SSN/Passport #
*
Business Name / DBA / Descriptor
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Corporate / Legal Business Name
Business Type
Association/Estate/Trust
Corporation
Government
International Organization
LLC
Medical/Legal Corporation
Non-Profit
Partnership
Sole Proprietor
Tax Exempt Organization
LTD
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Fed Tax ID / INTL Company
*
Merchandise/Services Sold
*
High Ticket Amount
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Average Ticket Amount
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Average Monthly Volume
*
Business Telephone Number
*
Business CS Number
Business Website Address
*
Business Email Address
*
Business Address
Suite/Apartment
*
City
*
State
*
Zip Code
Select Your Rates, Fees & Structure you are looking for (Call us at 888-395-9554 if you need assistance with rates)
Cash Discount (3.95% billed to customer) (0 processing fees for merchant)
Flat Rates (Example 3.85% Flat Rate)
Interchange Plus (Recommended)
Tired Pricing (1.69% plus 18 cents per transaction)
International Banking Rates
Line of Credit
Loan and financing
Consumers Product Financing
Date Business Established
Where should we send your money?
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Routing Number
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Account Number
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