Easy Secure Merchant Application

Please fill out the easy form below. We are here if you have any questions. Please call (800) 803-4592 if you need help with any aspect of this application.

II. Processing Data

Merchant Profile

Year Business Established 20212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900

Number of Locations 123456-1011-2021-5051+

Length of Ownership 0-12 Months1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9+ Years

Length at Location(s) 0-12 Months1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9+ Years

Type of Business

Retail

Internet

Restuarant

Lodging

Service

Trade/Craft Shows

Mail/Phone Order

Description of Goods Sold/Services Offered (the more detailed the answer, the faster the application is approved)

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Credit Card Transaction Profile

Primary Method of Accepting Credit Cards

In Person

Mail/Telephone

eCommerce/Internet

Secondary Method of Accepting Credit Cards (If Any)

In Person

Mail/Telephone

eCommerce/Internet

None

Estimated Maximum Monthly Volume

Estimated Average Ticket Amount

Estimated Highest Ticket Amount

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Easy Secure Merchant Application

Please fill out the easy form below. We are here if you have any questions. Please call (800) 803-4592 if you need help with any aspect of this application.

III. Additional Options

ACH is a secure method of moving money between banks without using paper checks, wire transfers, credit card networks, or cash. Using this method greatly reduces fees. Most of the time a client will simply input their checking account info to process their payment. It is quick and easy.

Would you like to add ACH as an additional processing method?

(This is a way to receive electronic checks to reduce your costs safely and securely.)

Yes

No

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Please estimate your average transactions and volume for clients who you think may want to use ACH versus a credit card to pay you.

Estimated Average Single Transaction Select... $100$101 - $500$501 - $1,000$1,001 - $3,000$3,001 - $6000$6001 - $10,000$10,000+

Estimated Average Monthly Volume Select... $100 - $1,000$1,001 - $2,000$2,001 - $5,000$5,001 - $10,000$10,001 - $50,000$50,001 - $100,000$100,000+

Estimated Max. Single Transaction Select... $100 - $1,000$1,001 - $2,000$2,001 - $5,000$5,001 - $10,000$10,001 - $50,000$50,001 - $100,000$100,000+

Estimated Max. Monthly Volume Select... $100 - $1,000$1,001 - $2,000$2,001 - $5,000$5,001 - $10,000$10,001 - $50,000$50,001 - $100,000$100,000+

Please enter the estimated percentage of how your ACH Transactions will be processed (must be equal 100%):

Consumer Transactions

Corporate/Business Transactions

Telephone Transactions

Web Transactions

Would you like to accept American Express Cards?

Yes

No

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By checking this box, Merchant elects to accept payments via American Express (Ineligible Merchants will not be enrolled). Merchant may opt out of accepting American Express Cards at any time without directly or indirectly affecting its rights to accept other Cards. Note: If you are currently accepting American Express, please provide the Merchant Number here:

By checking this box, Merchant opts out of receiving future commercial marketing communications from American Express. Note that you may continue to receive marketing communications while American Express updates its records to reflect your choice. Opting out of commercial marketing communications will not preclude you from receiving important transactional or relationship messages from American Express.

Easy Secure Merchant Application

Please fill out the easy form below. We are here if you have any questions. Please call (800) 803-4592 if you need help with any aspect of this application.

IV. Depository Account (This is where all of your money will be deposited.)

Banking information is required because the credit card company will deposit your transactions directly into your bank account daily. All data is secure and encrypted and only used by the bank processing your credit card transactions. No data is stored on premises.

Easy Secure Merchant Application

Please fill out the easy form below. We are here if you have any questions. Please call (800) 803-4592 if you need help with any aspect of this application.

Ask Abby

V. Owners/Officers (Must reflect ownership of 25% or more)

Thank you. Your application has been received but there is a few last optional steps.

In order to process your application faster, please attached a scan/copy of a voided check (from the same company name on this application) and a scan/copy of a government issued ID (Driver license, passport, state ID, etc.)

Voided Check

Drag & drop files here to upload

Government Issued ID

Drag & drop files here to upload

Bank Statement

Drag & drop files here to upload

Previous/Current Merchant Processing Statement

Drag & drop files here to upload

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