New Account Activation

Congratulations! You are on your way to increasing your sales and profits by accepting credit cards for your business.

For your privacy and security, your account information is kept safe with the highest grade of commercially available encryption. Your information will be kept completely confidential and will not be shared with anyone.

In order to complete the setup and activation process and start accepting credit cards from your customers, please provide us with the information requested below.

Required items are marked with (*)


*Legal Business Name
*Doing Business As (DBA) (if applicable)
*Email Address
*Business Phone Number
*Business Fax Number (optional)
*Business Street Address (No PO Boxes)
*Business City
*Business State
*Business Zip
*Website Address (if applicable)
*Number of Employees
*Business Location

*First Name
*Last Name
*Title
*Ownership Percentage	%
*Date of Birth	/ /
*Social Security Number
*Drivers License Number
*State Issued
*Expiration Date	/ /
*Home Phone
*Home Address
*Home City
*Home State
*Home Zip

*Describe Products and Services Sold in Detail
* $ Total Monthly Credit Card Sales (estimated)
* $ Average Individual Credit Card Sale Amount (estimated)
* $ Highest Individual Credit Card Sale Amount (estimated)
*What Is Your Refund Policy?
*Business Structure:
*Month and Year Business Formed	/
Are you now processing or have you ever processed credit cards for this business?	Yes No
*Name of processor
*Do you wish to accept American Express?	Yes No
Please provide expected percentages for each method of accepting credit cards. The percentages you enter must total 100%
*Card swipe through a terminal	%
*Imprint of card with signature without swipe	%
*Mail/phone/fax order	%
*Internet	%
*Total:	%
What is the timeframe from the credit card transaction to delivery of the product/service? The percentages you enter must total 100
*0-7 days	%
*8-14 days	%
*15-30 days	%
*Over 30 days	%
*Total:	%
*Federal Tax ID Number
*
*Bank Name
*Bank Account Number
*Bank Routing Number