Apply For A Merchant Account

Please fill out the form below to get your Merchant-account set up. If there's anything you're not sure of, just make your best guess and we can update it after you click "Submit" and before you E-sign the Link that we send you.

General Information

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

 

Business Details

% of Business Swiped (versus Keyed versus Internet)
Describe Goods/Services sold
"SIC" Code (4-digit Standard Industrial Classification – Don't worry if you don't know yours, you can leave it blank or easily look it up here)
When are products/services delivered?
Average CC Transaction Size (Approx)
Maximum CC Transaction Size (For Now)
Estimated Monthly 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
% of Company Ownership
Principal Title (Owner, President, Co-Owner, LLC Partner, Exec Director, Other)
Principal Birthdate (mm/dd/yyyy)
Principal SSN (US) /Social Insurance # (Can)
Used to verify US/Canadian Citizenship only. Not for Credit-check (except for Sole-Proprietors)
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
Any Prior Personal Bankruptcy (No/Yes)

 

Since you own less than 75% of the company, please provide information about the second owner.

I don't have their information right now but can send it to you separately.

Second Owner Information

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

 

Checking Account Information

Bank Name
FID # (3 digits)
Routing/Transit Number
Account Number
Re-enter Checking Account Number
Checking account # doesn't match

 

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?
Estimated Average E-check Transaction Size:
Estimated Maximum E-check Transaction Size:
Estimated Monthly E-check $ Volume:
Do you want to accept American Express?
Existing Amex Merchant # (if applicable)
Accounting Software?
How did you hear about Freedom Merchants?
if Other, please specify:
Who is your Bookkeeper?
How much is:
Answer:
Checking account # doesn't match

Thanks!

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