Edit Merchant Application

Merchant Onboarding Application

Form Instructions: * Required fields • Optional fields

First Name *

Last Name *

Middle Initial

Date of Birth *

Email Address *

Day Phone *

Evening Phone *

Social Security Number

Are you a US Citizen? *

Nationality

Notification Email (Optional)

Culture Code

Street Address *

Address Line 2

Apartment/Suite

City *

State *

ZIP Code *

Country *

Legal Business Name *

Doing Business As (DBA)

Employer ID Number (EIN) Required for businesses, mutually exclusive with SSN

Business Description *

Business Address

Business Address Line 2

Business City

Business State

Business ZIP Code

Business Country *

Monthly Bank Card Volume ($) * Enter amount in pennies (e.g., 10000 = $100.00)

MCC Code

Website URL

Average Ticket Amount ($)

Highest Ticket Amount ($)

Credit Card Information (for Setup Fees)

This information is required to pay for merchant account setup fees.

Name on Card *

Card Number Card number is encrypted and cannot be edited once saved.

Expiration Date *

ACH Information (Alternative Payment Method)

Optional - provide if you prefer ACH instead of credit card for setup fees.

Account Number

Routing Number

Account Type

Primary Bank Account Information

This is the bank account where you will receive payments from credit card transactions.

Account Holder Name *

Bank Name *

Account Number Account number is encrypted and cannot be edited once saved.

Routing Number *

Account Country *

Account Type *

Account Ownership *

Beneficial Owners

Individuals who own 25% or more of the business will be reviewed during the application process.

Beneficial Owner Information
If your business has beneficial owners (individuals owning 25% or more), their information will be collected and verified during the application review process.

Card Usage Statistics

Estimated percentages of different card transaction types.

Card Present Percentage (%) Percentage of transactions that are swiped, chipped, or tapped

Card Not Present/Ecommerce Percentage (%) Percentage of online/ecommerce transactions

Risk Assessment & Device Information

Additional information for fraud prevention and device ordering.

Merchant Source IP

Threat Metrix Policy

Threat Metrix Session ID

Device Ordering Information

Card processing devices and terminals for your business.

Device Name

Device Quantity

Device Attribute Name

Device Attribute Value

Device Time Zone

Document Upload

Upload required documents for identity verification and business licensing.

ID Document Type

ID Document Number

ID Document Expiration

Business License

Upload your business license (PDF, JPG, PNG)

Bank Statement

Upload a recent bank statement (PDF, JPG, PNG)

Tax Document

Upload tax document (PDF, JPG, PNG)

Document Requirements:

All documents must be clear and legible
Accepted formats: PDF, JPG, PNG
Maximum file size: 10MB per document
Documents will be encrypted and stored securely

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