Merchant Payment Card Application/Agreement Let's get a few details about your business.
1 Business 2 Product 3 Ownership 4 Equipment 5 Banking 6 Review Merchant Payment Card Application/Agreement I. Business Information All fields in this section are mandatory.
Type of Ownership Select ownership type Sole Proprietor Partnership Corporation Limited Liability Companies Non-Profit Government
Important Notice: Failure to provide accurate Legal Business Name, TIN, EIN and/or SSN may result in a withholding of merchant funding per IRS regulations. See section XII 1a-c IRS Reporting - Backup Withholding Certifications.
Corporate Address and Information State Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Physical Address and Information Business Type Select business type Retail Retail w/Tip Mail/Phone Internet Restaurant Fast Food Lodging Convenience Petroleum Pay at Pump Petroleum Pay Clerk Supermarket Car/Truck Rental Charity Utility Government Emerging Market Public Sector Passenger Transport Insurance Bill Pay Real Estate Bill Pay SIIPS/Cable Recurring SIIPS/Telecom Recurring Timeshare Cruise Line / Steamships Airlines/Carriers Cash Advance/Banks Only
Percent of Business (MUST = 100%)
Total: 0%
Sales Method (MUST = 100%)
Total: 0%
List all 3rd-party agents that have access to cardholder data