Pre Application

Pre Application Form

Type of Payment Method

Type of Account required:

Name of Business:

First Name

Last Name

Contact Email

Business Address:

Address Line 1

Address Line 2

City

State

Zip Code

Country

Daytime Phone:

Business Fax:

Legal Name of Business:

Principal Owner:

Type of Product or Service Sold:

Age of Business:

What credit cards do you currently accept ?:

Who is your current processor

Indicate Monthly Visa and MasterCard volume:

What is your average sales ticket

What is your website url:

Which country are you incoporated in?:

What percent is your monthly chargebacks?:

Direct or 3rd Party Account (new business):

Comments or Message

Offshore High Risk Merchants
Domestic and International Merchant accounts