Champion Payments Account Application

Fill out the secure form below and we will get you set up ASAP. Don't forget the 2 file uploads!

Business Legal Name *

Business DBA *

Business Entity Type *

Business EIN *

Business Start Date *

State of Entity Registration *

Business Phone *

Address *

Business Street Address

Country

State

City

Postal code

Website

Estimated Monthly Credit Card Volume *

Estimated Average Ticket *

Estimated High Ticket *

Percent of Keyed Credit Card Transactions *

Signer's First Name *

Signer's Last Name *

Signer's Phone *

Signer's Email *

Signer's Social Security Number *

Signer's Date of birth *

Signer's Home Address *

Signer's Home City, State, and Zip *

Business Bank Name *

Business Bank Routing Number *

Business Bank Account Number *

Signer's Drivers License

Scan/Photo of Signer's Drivers License

Voided Check

Scan/Photo of Voided Business Check

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