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Business Information

Broadcast MediaPrint MediaDirect MarketingInternetSocial Media

Corporate Information

Use provided business address

Owner or Authorized Signer Information

NoYes

Owners with 25% or more ownership must be represented on the application. Do you have additional owners to add?

NoYes

Secondary Owner or Authorized Signer

NoYes

Owners with 25% or more ownership must be represented on the application. Do you have additional owners to add?

NoYes

Third Owner or Authorized Signer

NoYes

Owners with 25% or more ownership must be represented on the application. Do you have additional owners to add?

NoYes

Fourth Owner or Authorized Signer

NoYes

Owners with 25% or more ownership must be represented on the application. Do you have additional owners to add?

NoYes

Fifth Owner or Authorized Signer

NoYes

Mailing & Shipping Information

Credit Card Processing Information

NoYes
NoYes
NoYes NoYes

Please estimate the dollar amount of credit card transactions you will receive in each of the following sources:

What is the percentage of your Visa Volume, Mastercard Volume, Amex Volume and Amex average transaction? The total of all three should equal 100%.

NoYes
NoYes NoYes

Bank Draft EFT/ACH Information

IMPORTANT INFORMATION CONCERNING ACH/EFT LIMITS:

Please make sure you set your daily and monthly limits to cover your processing volume. Setting these limits too low will result in transactions being rejected by the processor and delays in getting your limits raised and transactions re-processed. Also make sure that you consider your billing frequency. For example, if you bill on only one or multiple days per month make sure your DAILY limits will handle all of the volume anticipated.

Bank drafts are also known as ACH or EFT (Electronic Funds Transfer) transactions and involve you using a customer's bank account and routing number. If you only wish to be able to process a debit card, then you do NOT need to sign up for this service as those can be processed by accepting credit cards.

NOTE: This option is not available for all software applications.

NoYes NoYes

PCI Compliance and Integration Information

Every U.S. merchant that accepts credit cards is required to be PCI compliant. Failure to comply can result in you and your business being responsible for penalties up to $500,000.00.

Along with your new merchant account, you will be enrolled into our PCI Plus program. This program provides up to $20,000 in Breach Financial Assistance.

Once you are set up with your account, you will receive access to the "PCI Compliance Manager" tool – an online questionnaire that helps you quickly and easily maintain and report compliance. Please complete the questionnaire within 90 days from your account activation date to avoid an additional monthly PCI non-compliance charge.

Check this box to indicate that you have read and agree to all of the above.