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Contact Us
About Us
Services
ACH Payment Processing
Chargeback Prevention Tips
Merchant Cash Advance & Merchant Financing
Nextiva
Panama Call Room
Seo Services
Web Development Services
Referral Partnerships
BLOG
Industries
Adult Merchant Account
Airline & Jet Charter Merchant Accounts
Auto Transport Merchant Accounts
Auto Warranty Merchant Accounts
Bail Bonds Merchant Accounts
Business Consulting merchant accounts
CBD Merchant Account Solutions
Collection Agency Merchant Accounts
Coins & Collectables
Continuity Subscription
Credit Repair Merchant Account
Debt Relief Merchant Accounts
Debt Consolidation Merchant Accounts
Document Preparation Merchant Accounts
Dropshipping Merchant Accounts
Educational Seminar Merchant Accounts
Firearms Retailers Merchant Accounts
Health & Beauty
Jewelry Merchant Accounts
Online Dating Industry Merchant Accounts
Moving Broker Merchant Accounts
MOTO
Nutraceutical Merchant Accounts
Pharmacy Merchant Accounts
Ticket Brokers
Travel Agency Merchant Accounts
All High Risk Merchant Accounts
(877) 441-6801
Contact Us
Home
About
Services
ACH Payment Processing
Chargeback Prevention Tips
Merchant Cash Advance & Merchant Financing
Nextiva
Panama Call Room
Seo Services
Web Development Services
Affiliate Referral Partnerships
Blog
Industries
Adult Merchant Account Solutions
Airline & Jet Charter Merchant Accounts
Auto Transport Merchant Accounts
Auto Warranty Merchant Accounts
Bail Bonds Merchant Accounts
Business Consulting merchant accounts
CBD Merchant Account Solutions
Coins & Collectables
Collection Agency Merchant Accounts
Continuity Subscription
Credit Repair Merchant Account
Debt Relief Merchant Accounts
Debt Consolidation Merchant Accounts
Document Preparation Merchant Accounts
Dropshipping Merchant Accounts
Educational Seminar Merchant Accounts
Firearms Retailers Merchant Accounts
Health & Beauty
Jewelry Merchant Accounts
Online Dating Industry Merchant Accounts
Moving Broker Merchant Accounts
MOTO
Nutraceutical Merchant Accounts
Pharmacy Merchant Accounts
Ticket Brokers
Travel Agency Merchant Accounts
All High Risk Merchant Accounts
(877) 441-6801
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Business Info
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Legal Business Name
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Years in Business*
*
DBA Name (if applicable)
Referred by (if applicable)
Business Physical Address
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Address Line 1
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Time at this location
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Full Name of Business Contact Person
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Business Contact Title
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Tax ID
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Corp. Type
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> Limited Liability Company (LLC)
> S Corporation
> Corporation
> Partnership
> Sole Proprietorship
Corp. State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
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Northern Mariana Islands
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U.S. Virgin Islands
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Virginia
Washington
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Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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Business Bank
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Routing Number
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Ownership Info
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Principal Owner Name
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% of Ownership
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Address
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Address Line 1
Address Line 2
City
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
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Wisconsin
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Zip Code
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Email
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Phone
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Any Additional Owners?
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Principal Owner Name
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% of Ownership
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Address
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Address Line 1
Address Line 2
City
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
State
Zip Code
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Email
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Phone
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Processing Info
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How many transactions (debits) will you process per month?*
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> 1-25
> 26-99
> 100-499
> 500+
Highest amount you receive on any single transaction
*
Do you have Recurring Payments?
*
Yes
No
What % of Monthly Volume is Recurring?*
> 1%-10%
> 11%-25%
> 26%-49%
> 50%+
What is the average dollar amount per transaction?*
*
> $1-$99
> $100-$499
> $500-$999
> $1,000-$4,999
> $5,000+
Estimated monthly dollar amount of transactions?
*
What is your refund policy?
*
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What is the average dollar amount per refund?
*
What is your estimated monthly dollars refunded?
*
Describe how you market your goods or services
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Do you require website integration?
*
Yes
No
What type of website integration do you require?
*
WooCommerce
Shopify
Magento
Debt Pay Pro
Rest API (Used for CRMs, Websites, etc...)
Other
Select all types of goods or services provided by your business.
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Animal Services
Audio/Visual Services
Auto Services
Beauty Products
Billing Services
Business Consulting
Business Software
Clothing/Apparel
Collection Agency
Construction
Credit Consulting
Divorce Assistance
Document Preperation
Educational Services
Equipment Sales
Financial Consulting
Financial Services
Fitness
Food Services
Furniture Sales
Gold & Silver
Health/Wellness Services
IT Services/Software
Kratom
Legal Services
Marketing Services
Medical Equip/Supply
Merchant Services
Moving Company
Online Entertainment
Online Services
Packing/Shipping Supplies
Peptides
Real Estate/Property Management
SARMS
SEO Consulting
Smoking Accessories
Sport Services
Supplements
Tax Services
Travel Services
Other
Document Upload
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Copy of Owners Driver’s License or Passport
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Max. file size: 50 MB.
Articles of Incorporation
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*Additional documents may be required
Bank Document showing business name
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Max. file size: 50 MB.
Copy of EIN, SS4 or last years tax filling
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