Apply For A Merchant Account

Fill out the form below to have your merchant account setup. Once it's setup you can start processing immediately.

General Information

Name of Account ("DBA" Doing Business As - appears on Receipts)
Location Address
Location City
Location Country
Currency you wish to Receive Funds in
Location State/Province
Please select a country
Loc Zip/Postal Code
Click Here only if Billing Address different from Location Address
Location Phone Number
Corporate Office Phone # (if different from Location)
Website Address
Corporate Email Address
Legal Tax Filing Business Name
Corporate Tax ID-# ("FEIN #" or EIN-# or Business-Number BN#)
Primary Client Contact(s) Name

 

Business Details

% of Business Swiped (versus Keyed versus Internet)
Describe Goods/Services sold
When are products/services delivered?
Average Transaction Size (Approx)
Maximum Transaction Size (For Now)
Estimated Annual $ CC Volume
Refund Policy
If Policy Other, Which (Max 75 Characters):
Type of Ownership
Date Started Business (MM/DD/YYYY)
# of Locations

 

Principal Information

Principal Owner - First Name
Principal Owner - Last Name
Principal Title (Owner, President, Co-Owner, LLC Partner, Exec Director, Other)
Principal Birthdate (mm/dd/yyyy)
Principal SSN (US) /Social Insurance # (Can)
Principal Driver's License #
Principal Driver's License State/Province
Home-based Business?
Home Street Address of Principal
Home City of Principal
Home State/Province of Principal
Home Zip/Postal of Principal
Principal Own/Rent Home
# of Years at Home-Address
% of Company Ownership
Any Prior Personal Bankruptcy (No/Yes)

 

Checking Account Information

Bank Name
Routing/Transit Number
Account Number

 

Credit-Card Information

(for USD$12/month and $0.05/transaction Gateway Fee, only charged if application approved)
Credit Card #
Expiration Date
CVV

 

Additional Information

Currently Processing Credit-Cards?
Do you want to accept E-Checks/ACH too?
Do you want to accept American Express?
Existing Amex Merchant # (if applicable)
How did you hear about Freedom Merchants?
if Other, please specify:
How much is:
Answer:

Thanks!

We have received your application and we will be in touch shortly.
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