Pre Application

pre application

Type of Payment Method:

Type of Account required:

Name of Business:

Contact Name:

Contact Email:

Business Address:

State/Province:

Zip/Postal Code:

Daytime Phone:

Business Fax:

Legal Name of Business:

Principal Owner:

Type of Product or Service Sold:

Age of Business:

What credit cards do you currently accept ?:

Who is your current processor:

Indicate Monthly Visa and MasterCard volume:

What is your average sales ticket:

What is your website url:

Which country are you incoporated in?:

What percent is your monthly chargebacks?:

Direct or 3rd Party Account (new business):

Comments: