Apply Now – Merchant Application

High- Risk High Volume Accounts

Apply Now - Merchant Application

- BASIC CONTACT INFORMATION
- Username*
- First Name
- Middle/Second Name
- Last Name
- Phone* Required phone number format: (###) ###-####
- E-mail*
- password*
- BUSINESS OWNER INFORMATION
- Streed Adress*
- Address Line 2
- City
- State/Province
- Zip/Postal Code
- Country*
- date of Birth*
- Select Your ID Type*
- SSN or ID Number
- Passport
- COMPANY LEGAL INFORMATION
- Business Full Legal Name:
- Business DBA Doing Business as:
- Business ID/ Registration N
- Business Type
- Time in Business: *
- Business Website Address:
- Additional Websites Used....
- Business Address
- City
- Business Country
- Business Phone Number Required phone number format: (###) ###-####
- Business Email:
- Customer Support Number: Required phone number format: (###) ###-####
- Business Skype ID
- BUSINESS PARTNER IDENTIFICATION (Optional)
  (Optional)
- Business Partner(S) Full-Name
- First Name
- Last name
- Street Address
- Address Line 2
- City
- State/Province
- ZIP/Postal code
- Country
- Phone Number Required phone number format: (###) ###-####
- Email Address
- Bank Information
- Bank Name
- Bank City, Country*
- Name on Account*
- Bank Routing Number*
- Bank Account Number*
- Bank SWIFT Code
- Authorized Singner Full Name*
- Upload a Copy of Your Bank Statement For Deposits*Upload