Please fill out the secure intake form below to apply for a merchant account:

Business Details:

Legal Business Name *

DBA (Doing Business As) *

Corporate Phone *

Type of Ownership *

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LLC
Corporation
Sole Proprietor
Partnership
Non-Profit 501(c)(3)
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Corporate Address *

City *

State *

Zip Code *

Corporate Email *

Physical Address Same as Corporate Address *

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Yes
No
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If your physical address is different from your corporate address, please enter it below:

If your physical address has a different phone number, please enter it below:

What type of business or product is sold? *

What type of business or product is sold?

Date Business Started *

Processing Volume:

Average Ticket *

How much is your average card sale?

Monthly Bank Card Volume *

Please provide the average total amount you process in card payments each month.

Typical High-End Ticket *

Please provide the highest amount you anticipate charging in a single transaction. Additional documentation required for high ticket sales including but not limited to business bank statements and past invoices.

% Keyed (Card Not Present) *

What percentage of your card sales do are manually entered where the card is not present at the time of purchase (i.e., online or over the phone).

% Card Swiped / EMV *

What percentage of your card sales do are swiped, inserted, or tapped via EMV?

Sum of both these MUST BE EQUAL to 100.

Please upload 1-3 Recent Monthly Processing Statement (Required for High Ticket Limits and Free Equipment)

Do You Accept EBT or Food Stamps? *

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Yes
No
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FNS # (Required to accept EBT and/or food stamps)

If you accept food stamps and/or EBT payments, please enter your FNS number above.

Does your business take deposits/take payments for future delivery? *

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Yes
No
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Business Banking Information:

Bank Account Number *

Routing Number *

Upload a Voided Check or Bank Letter (highly recommended but not required)

Name of Bank *

Owner Information:

Owner's First Name *

Owner's Last Name *

Is your local residential address different from the address on your driver’s license?

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Yes
No
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If your local residential address is different from the address on your driver’s license, enter it here:

Owner Driver's License *

Ownership % *

Social Security Number *

Are you comfortable proceeding with a credit check as part of underwriting, knowing that it can be waived if needed, but may delay the process? *

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Yes
No
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Tax ID # or EIN # *

How did you find us?

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Sales Representative
Referral
Google
Instagram
Facebook
BNI
St. Petersburg Chamber of Commerce
Other
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Who is Your Sales Rep or Who Referred You?