Latest 3 Months of Credit Card Processing Statements

Click to upload 3 or more of your most recent credit processing statements

First Name *

Last Name *

Phone Number (where you can receive texts) *

Email Address *

Your Legal Business Name *

Your Company Website URL *

Has Your Business Accepted Credit Cards Before? *

How Do You Collect Payments? *

Transaction Percentages By Type (Must Equal 100%)

% Swiped (In-Person)
% Keyed (Over the Phone)
% Internet

Would You Like (or Do You Need) New Card Readers in Store or in the Field? *

Where Would You LIke to Have This Equipment Shipped?

I will be using my Home Address (filled out later in the application process)

I will be using my Business Address (filled out later in the application process)

I will be using a different address and enter it now

International & B2B Transaction Percentages *

% International
% B2B

When Do Customers Receive Their Products or Services?

What is the Business' Refund Policy? *

List the name(s) of any chargeback management systems, if any

List the name(s) of Fulfillment Center, Contact Name, Address, and Phone # or Email address, if any

List the name(s) of call center(s) providers, if any

What shipping service do you use to deliver products to your customers (if any) *

Sales Estimates *

VISA/MC/DS Monthly Credit Card Sales (In Dollars)
AMEX Monthly Credit Card Sales (In Dollars)
Average Amount Per Sale (In Dollars)
Estimated Highest Sale Amount (In Dollars)

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