SECURE ONLINE APPLICATION 

STEP ONE | Business Information
Do you want to accept Discover® Network?
 (Free Setup)		 Yes No
Do you want to accept American Express®?
(Free Setup) 		Yes No
Do You Currently Accept Credit Cards? Yes No
DBA (Doing Business As) Name
(The DBA must match the name on your checking account where you would like your credit card sales deposited)
Best Contact Phone Number
- -
Legal Name of Business
Company Contact First Name
Company Contact Last Name
Title or Relationship
E-mail Address   ( Approval Via Email )
Website Address
Business Phone Number
- -
Business Fax  Number
 - -
Business Address
Business City
Business State/Country
Business Zip Code
 
STEP TWO | Owner Information
Principal's First Name
Principal's Last Name
Date of Birth  (e.g., 01/01/1965)
/ /
Is There a Second Owner? Yes No
Home Phone Number 
 - -
Ownership %
Home Address - If home address is the same as business address, click this box:
Home City
Home State/Country
Home Zip Code
 
STEP THREE | Processing Information
Describe Products Sold (e.g., "I sell toys" )
Business Ownership Type
Home Business?
Yes No
Average Monthly Volume
$
Average Sale/Ticket Amount
$
Highest Average Sale/Ticket Amount
$
Business Type
How Are Your Products
   or Services Sold?
Years or Months in Business
Please, If You Remember, Where Did You Hear About Us?
Please Feel Free to Send Us Any Comments You May Have.
 

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