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Call Support Email Support Application Newsletter Get StartedBusiness DetailsBusiness ProfileTransaction DetailsOwnership DetailsPayment & Software Details Applicant NameBusiness NamePhone Number EmailWebsite (if applicable)PreviousNextLegal Business Name (as shown on federal tax ID)Business AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect Country Billing address is different than business addressBilling AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePreviousNextType of Ownership- Select -Sole proprietorshipIncorporationLimited liability company (LLC)Non-profitOtherFederal Tax IDTypes of goods or services soldBusiness type- Select -RetailRestaurantServiceSeasonalOnlineLodging/car rentalB2BMunicipalYear foundedNumber of locationsBusiness location type- Select -Retail location with store frontOffice buildingResidenceWarehouseOtherPreviousNextHow do you collect payments? (select all that apply)Swipe or insert cardManually keyed entryOnlineInvoicesOff-site (at the place of service)Average ticket sizeAverage monthly revenueHave you ever accepted VISA/MC/AMEX/Disc/PayPal? Yes NoHas this business or any business you have owned been terminated as a VISA/MC/AMEX/Disc/PayPal merchant Yes NoHas this business or any business you have owned filed for bankruptcy or been subject to involuntary bankruptcy? Yes NoPreviousNextOwner Legal First NameOwner Legal Last NameTitlePhone NumberOwnership % I own 50% or less of the businessOwner Legal First NameOwner Legal Last NameTitlePhone NumberOwnership %PreviousNextDo you currently accept credit and debit card payments? Yes NoWho is your current payment processor?Reason for switching processors?- Select -Too expensiveHigh ticket/held fund issuesCancelled contractPoor customer serviceOtherUpload copy of recent credit card processing statement (Optional)Upload Do you currently use Point of Sale or Accounting software that would require integration? Yes NoWhat software do you currently use? (if applicable) Previous Submit Form Need help or have questions about your application? Call Sales Email Sales After submitting your application, discover your solution. Visit our products page and view our card readers, payment gateway options, and more. Shop Hardware & Software × Payment Processing 101: Everything you need to know Supercharge your business with our payment processing e-book. Don’t miss this valuable resource! Download for Free
