Merchant Application

Legal Business Name *

DBA Name (if applicable)

Business Type *

LLC Partnership LP Individual / Sole Proprietor Corporation Private Coporation Public Corporation Other

Existing website (if applicable)

Business Tax Id/EIN *

Business Start Date *

Owner Email *

Owner Birthdate *

Owner SSN *

Country *

United StatesCanada

Address *

Address Line 2

City *

State *

Choose AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaMicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces Europe, Canada, Africa and Middle EastArmed Forces Pacific

Region *

Choose AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Postal *

Business Phone *

Deposit Info

This information allows us to connect your bank account to your merchant account.