Legal Business Name
Business Email Address
Phone number to discuss this application
Phone number to be listed on receipts
Use the 3 fields below to estimate the percentage of your business' credit card sales by payment type. Total must equal 100%.
eCommerce = Customer types their credit card details into your website's checkout page.
Phone = Employee types the customer's credit card details in after customer provides them over phone.
Retail = Customer provides you their physical credit card, in person, at the time of checkout.
Non-binding estimate of total monthly sales.
Non-binding estimate of a small typical sale size for your business.
Non-binding estimate of your average typical sale size for your business.
Non-binding estimate of a large typical sale size for your business.
Describe the product(s) your nutraceutical business sells.
What are the price(s) that your nutraceutical product(s) retail for?
Describe in a few words how your product uses or involves upsells.
Describe in a few words how your product uses or involves trial offers.
Include sub-affiliates, CPAs, and publishers. Enter "None" if does not apply.
Name the company to whom you outsource your product fulfillment.
Address of the company to whom you outsource your product fulfillment.
Phone number of the company to whom you outsource your product fulfillment.
Describe in a few words what inventory shipping reports you receive, how often, from whom, etc.
Name of the company(s) who manufactures the product(s) sold.
Approximately how many units per day of your product(s) is your manufacturer capable of producing.
On average, how much of the product is maintained in stock, either on-site or at the shipping facility.
Please reference the source of any performance claims made on your marketing materials about the product.
What are the hours of operation of your company's customer service.
If your business previously had a high number of chargebacks, the card associations may have required you to enroll in a chargeback monitoring programs (for example, MCMP, ECP).
"Doing Business As" Name to be listed on customer receipts.
Enter the state your business was incorporated in. If Non-US entity, select "Outside the US".
Non-US Addresses: Select "OUTSIDE US" in STATE field.
Select "Yes" if your business address is a PO Box or mailbox address.
You may use a virtual office for the business' mailing address, however, if an onsite inspection is requested by underwriting they will need the actual business' operating address (Note: listing a home address for home based businesses is permissible).
For non-US applicants, enter "000-00-0000"
For non-US applicants, enter "0000"
If you are an existing business, submit your 3 most recent business bank statements. For new businesses, submit the owner's 3 most recent personal bank statements.
If you've previously accepted payments, please submit your 3 most recent monthly statements from your previous payment processor.