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

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
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
"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
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?
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)
How did you hear about Freedom Merchants?
if Other, please specify:
Who is your Bookkeeper?
How much is:
Answer:

Thanks!

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