Complete Merchant Account Application:

Select Each Type Processing Being Applied For:

Credit Card - Details - All merchants over $10,000.00 per month card volume or over $500.00 per transaction.  Include e-Merchantview reporting

Online Electronic Checks  - Details - For accepting check payments online

Checks By Phone - Details - For accepting check payments by phone

Visa POS Check Services - Details - For Electronic Check Verification/Conversion at point-of-sale

Recurring Payments - Details - For accepting Automated Scheduled Payments by check or credit card

Consumer Check Acceptance Verification - Details - For verification of consumer check presenter's check

Payroll Check Cashing Verification Services - Details - For verification of payroll checks

Wireless Remote Check And/Or Credit Card Processing - Details - For delivery & outside sales people equipped with cell phone or laptop wireless processing device 

FREE Check Re-Presentment & Collection Services - Details - For returned check re-presentment & collection of checks full face value

FREE Check Guarantee Small Ticket Program - Details - For checks $25 or less

Pre-paid Card Reseller Program - Details - For merchant resellers wanting to sell a full line of pre-paid card products on consignment 

Legal Business or Corporate Name:

Legal Business Street Address: 

City: State: Zip:

Billing Address: 

City: State: Zip:

Business Phone: Fax: 

Web Site URL: 

Email Address:

Type Of Business Structure (Select One): Sole Proprietorship   Partnership   LLC 

Corporation

Age Of Business: Years       Date Business Was Acquired:

Type Of Business:     

Type Of Products Or Services offered:

Business Federal Tax ID Number:

Primary Contact Person (First, Last Name & Title):

Primary Contact Phone Number: 

Primary Contact Email Address:

Doing Business As Name:

DBA Storefront Street Address: 

City: State: Zip:

Do You Have Multiple Storefront Locations?           Yes            No         

If Yes, How Many Locations?

For Multiple Locations, Please Provide Required Information On Multiple Location List.

Complete the following information if application is for any Check Services.

NUMBER OF CHECKS:     

Average # Per Day:   Maximum # Per Day:

DOLLAR AMOUNT PER CHECK: 

Average Amount:     Maximum Amount:

TOTAL DOLLAR AMOUNT OF CHECKS: 

Average Per Month              Daily Maximum:

Complete the following information if application is for Credit Card Services.

NUMBER OF Credit Card Transactions:     

Average # Per Day:   Maximum # Per Day:

DOLLAR AMOUNT PER CREDIT CARD TRANSACTION: 

Average Amount:     Maximum Amount:

TOTAL DOLLAR AMOUNT OF CREDIT CARDS: 

Average Per Month              Daily Maximum:

TYPE OF CARD TRANSACTIONS:

Percent of Swipe Transactions:    Percent of Online Transactions :

Percent of Phone Transactions:    Percent of Keyed Transactions :

BANK DEPOSIT INFORMATION:

Bank Name: 

Bank Contact: Contact Phone #:

Bank Address: 

City: State: Zip:

Bank Routing #:           

Bank Account #:

BUSINESS OWNER / OFFICER INFORMATION:

President Or Owner’s Name / Title:  

Equity % Ownership:Social Security #:          

Date Of Birth:        Age:

Residence Address: 

City: State: Zip:

How Long At Address:        Own       Rent     

Home Phone:

Second Officer Or Co-Owner’s Name Title:    

Equity % Ownership:Social Security #:          

Date Of Birth:        Age:

Residence Address: 

City: State: Zip:

How Long At Address:        Own       Rent     

Home Phone:

STOREFRONT SITE SURVEY:

Type Of Building: Shopping Center  Office Building  Residence  Storefront 

Other  

Area Zoning:  Commercial       Industrial             Residential         

Square Footage: 0 -250        250 - 500           500 - 2,000       2,000 Plus

Is The Amount Of Inventory At The Location Consistent With The Type Of Business And Projected Sales

Volume? Yes  No

If "No" explain:

Survey Overall Comments:

For security, please perform the following:

1. Pass your mouse over each photo below and "Click" one time on each "Cat" photo

2. After you have selected each cat photo, "Click" on the "Submit Information" bar.

If you need help, please contact us at 903-451-9590

between 8:00 A.M. - 5:00P.M. CST Monday - Friday.