Only certain fields are required to submit this form and are noted with an asterick (*), but to help us prepare before we call or email you, please enter as much information as possible.

Business Name - This is the official legal entitiy name for your business .

DBA - Doing Business As:  The alias you used to register your business with the local city or county.  In order to apply for a merchant account under this DBA, your bank must recognize this name as well.

Describe Products/Services Sold - A brief explanation of what your business sells.  This helps us determine the Standard Industry Code 'SIC' of your business

Estimate How you will Accept Cards
Swiped - The percentage of credit cards will be physically swiped through an electronic processing terminal and you will be able to verify the cardholders' identity with other supporting IDs.

Imprinted - The percentage of credit cards that an imprint of the card will be taken for later manual entry into credit card processing system.  You will be able to verify the cardholders' identity with other supporting IDs.

Card Not Present - The percentage of credit cards that you will be taking the card numbers and expiration dates over the phone, through the mail order, or over the Internet and will not be able to personally verify the customer's indentity.

Home Business - You operate your business from your home and have no other permanent business location.

Estimated Average Ticket - This is what a typical sale would be that is charged on a credit or debit card.

Estimated Monthly Volume - What you anticipate you will be processing per month within the first six to eight months of processing.  Underwriting reviews you and your business credit history combined with the estimated monthly volume for approval.  Requests for additional volume need to have a miniumum of six months of processing to review.

Estimated High Ticket - What a potential high ticket might be.   The requested monthly volume should be higher than an estimated High Ticket.