Merchant Application Form

eData Application form:

Owner Title
Owner Equity Percentage
First Name*
Last Name*
Home Address
Suite/Apartment
City
State
Zip Code
Cell Telephone Number*
Date of Birth
Date Format: MM slash DD slash YYYY
SSN or Passport #
Business Name / DBA / Descriptor
Corporate / Legal Business Name*
Business Type
Fed Tax ID
Merchandise/Services Sold
High Ticket Amount
Average Ticket Amount
Average Monthly Volume
Business Telephone Number
Business Fax Number
Business Website Address
Business Email Address*
Business Address
Suite/Apartment
City
State
Zip Code
Select Your Rate Structure (Call us at 888-395-9554 if you need assistance with rates)
Where should we send your money?
Routing Number
Account Number / IBAN