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.
"Doing Business As" Name to be listed on customer receipts.
Enter the state your business was incorporated in.
Select "Yes" if your business address is a PO Box or mailbox address.
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 monthly statements. For new businesses, submit the owner's 3 most recent personal bank statements.
If you've previously accepted credit cards, please submit your most recent 3 monthly statements from your previous credit card processor.