New Merchant Inquiry We can only work with Merchants Incorporated in US, Canada, Latin America, Australia, New Zealand, Switzerland, and the European Union. "*" indicates required fields Business InfoWe can only work with Merchants Incorporated in US, Canada, Mexico, Australia, New Zealand, Switzerland, and the European Union.Country of Incorporation or Registration*Choose a countryUnited StatesAustraliaAustriaBelgiumBulgariaCanadaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryHong KongIrelandItalyLatviaLuxembourgLithuaniaMaltaMexicoNetherlandsNew ZealandPolandPortugalRomaniaSlovak RepublicSloveniaSpainSwedenSwitzerlandUnited KingdomWe are unable to work with Merchants incorporated in IndiaCitizenship of Owner*Choose a countryUnited StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweIndustry of Business*Choose your industry3D Printers Specifically Designed to Create FirearmsAccounting and BookkeepingAdoption AgenciesAdult Content / Hentai / Memberships / Webcams / Phone SexAdult Products (Sex Toys)Advertising For Real EstateAirlinesAlcohol (Internet Wholesale)AmmunitionAnonymity / IP Address Masking ServicesAsset Protection / Venture CapitalAudiotextAuto DetailingAuto Rental AgenciesAuto Roadside AssistanceAuto TransportAutoparts OnlineBackground ChecksBail Bond ServicesBankruptcy Lawyer / FirmBartering ServicesBinary Options Trading & ForexBitcoinBitcoin ATMBus LinesBusiness Consulting (Financial)Business OpportunityCannabis SeedsCar Service / LimoCash GiftingCasino Gambling or Gaming EstablishmentsCBD ProductsChain LettersCharitiesCheck Cashing ServicesCircumvention Devices (Black Boxes)Coins / Collectibles / Gold / Precious MetalsCollection Agencies / Debt CollectionComputer Bulletin BoardContinuity Billing – Ingestible Products (No Trial Offers)Continuity Billing – Ingestible Products (With Trial Offer)Continuity Billing – Topical (Skin) Products (No Trial Offers)Continuity Billing – Topical (Skin) Products (With Trial Offer)Coupon / Gift CertificatesCredit Card Protection ServicesCredit Cards (Pre-Paid or Not Pre-Paid)Credit EducationCredit RepairCredit Report MonitoringCRM (Contact Relationship Manager)CrowdfundingCrypto / Virtual Currencies / BitcoinCurrency ExchangeCyber LockersDebt CollectionDebt ConsolidationDebt CounselingDecryption ProductsDetective ServicesDiscount LegalDiscount Shopping / Coupon Membership ClubDistressed Property Sales & MarketingDominatrixDoor to Door SalesDrug ParaphernaliaE-Wallet LoansElectronic Cigarettes / E-CigsEmbassies / Consulates / Foreign GovernmentsEmployment AgenciesEphedraEscort AdvertisingEscort ServiceESTA / Immigration / Visa Passport ServicesExtended Warranty (Car / Auto)Extended Warranty Programs (Non-Auto)Fantasy / Nude ArtFantasy SportsFile SharingFinancial ConsultantsFinancial InstitutionsFirearmsFireworks and ExplosivesForeclosure ProtectionFortune TellersFreight ForwardersFulfillment HousesFulfillment MerchantsFurnitureGentlemen’s and Strip ClubsGovernment Grants / Financial AidHair Restoration ServicesHCG Weight LossHemp ProductsHigh Ticket CoachingHome Buying AssistanceHoverboardsHuman Growth Hormones (HGH)ID Theft ProtectionIn Home Computer Hardware / Software Sales or ServiceIncorporation ServiceInfomercial MerchantsInsurance BrokersInternet / Mail-Order GamblingInternet / Mail-Order Handbags or WatchesInternet Pawn ShopInvestment AdviceIT Services / Tech SupportJail Breaker Equipment / SoftwareJamming Devices (Cell Phone Services)K2KratomSpiceGenieKronicSalvia Divinorum or IncenseLead GenerationLegal Services OnlineLimo ServicesLive AnimalsLive Video Chat (Adult)Loan BrokerLoan Modification / Mortgage Brokers / Reduction Services / RefinancingLoan RepaymentLong Distance ServicesLotteryMagazine SubscriptionsMagic SuppliesMale Enhancement (One-Time Billing)Male Enhancement (Trial / Continuity)Manga AnimationMassage (Home Based)Massage ParlorMatch Making ServiceMedical ConsultationMedical Discount Plans / Insurance SubstitutesMedical or Dental DevicesMLM (Multi Level Marketing)MMJ Medical DispensaryMMJ DispensaryMobile AppsMobile RepeatersModification ChipsMoney Service BusinessNon-Financial Institutions: Foreign CurrencyMoney OrdersScriptTraveler’s ChecksNootropicsNutraceutical / Health & Beauty (Straight Sale)Nutraceutical / Ingestible (Straight Sale)Online AuctionsOnline Computer SalesOnline Dating / Matchmaking ServiceOnline Incorporation ServicesOnline Legal CertificatesOnline MarketplaceOnline PharmacyOnline SneakersOnline Tobacco / CigarettesOnline Wheel SalesOtherP2P PaymentsPari-Mutuel BettingPassenger RailwaysPayday / Installment LoansPayment FacilitatorsPenny AuctionsPeptidesPre-Paid Legal Advice / Product Authentication ServicesPre-Paid Phone CardsProcurement ServiceProduct Authentication ServicesPromotional MaterialPsychic (Mail Order Telephone Order or E-Com)Pyrotechnic DevicesRadioactive MaterialReplicasReputation ManagementResearch ChemicalsScholarship ProgramsSearch Engine Optimiztion (SEO)Self Help BooksSeminars (Mail Order Telephone Order or E-Com)Shipping ServicesSkincare / Nutra (Straight Sale)Software Downloads (Music / Movies)Sports CardsSports ForecastingSpread BettingStock Trading TipsStop Smoking AidsStripper ServiceStudent Loan Consolidation Document PreparationSwingers Club / DoggingTalent AgenciesTax Relief or Fine Reduction AssistanceTeeth Whitening Products (Continuity / Subscription)Teeth Whitening Products (One-Time Purchase)TelemedicineTelephony Services (VOIP)Tenant Screening ServicesThird Party Timeshare AgentsTicket Brokers (Fulfillment Over 90 Days)Ticket SalesTravel (Including Airfare)Travel AgencyTravel CertificatesTravel Hotel BookingsTravel Member ClubTravel MLMTravel Packages (Without Airfare)Travel: Cruise LinesTravel: Timeshare AdvertisingTravel: Timeshare Contract NegotiatorsVIAGRA OnlineVideo On DemandVPN ServicesWater PurifiersWeaponsWeb DesignWeb HostingWebsites / Applications With Cash PrizesWeight Loss Centers (Non-Physician Based)Wheel ClampersWholesale Mobile Phone SalesWire Transfer / Quasi CashWhat Industry?* Customer Breakdown by Country*Please provide an estimated breakdown of which countries you sell in and the % of sales to each country (ex: 40% EU, 40% US, 20% Rest of World)Country of Settlement Bank Account*Select a countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsLegal Business Name* DBA Name* Do you have a business license?* Yes No In what countries is your business licensed?*Are you able to provide 1 to 3 months of processing statements?*Merchants who provide processing history are more likely to get approved for a merchant account. Yes No Have you ever had a Merchant Account Terminated?* Yes No For what reason was your account terminated?*Processing RequirementsWebsite* Do customers have the ability to create an account on your website?*This is typically used to log in and see orders, account info, etc. Yes No Please create a test user account for Underwriters to use. They will need to see the section of your website that is restricted for customersTest Username Test Password Referral Group (optional) Do you automatically rebill your customers?* Yes No Currency of Settlement Funds* Average Transaction Amount ($)*Please enter a number from 0 to 100000000.Estimated Monthly Credit Card Sales Volume ($)*Please enter a number from 0 to 100000000.Maximum Transaction Amount ($)*Please enter a number from 0 to 100000000.DetailsDetailed description of product or service you sell:*Anything else you'd like us to know about your business:Contact InfoName* First Last Mobile Phone*Email* Upload Processing Statements3 Months Previous Credit Card or ACH Processing Statements (if available) Must be downloaded or scanned copies of the full monthly statement, not merely screenshots. These are available through your previous/current merchant account provider’s online login, or by calling your old credit card processor. For new businesses, or if you haven’t accepted credit cards in the past, omit this requirement. If, however, your bank statements indicate you’ve accepted credit cards in the past, you cannot be approved without providing those documents.Processing Statement 1MonthChoose OneJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYearChoose one202220212020Processing StatementAccepted file types: jpg, png, jpeg, gif, pdf, csv, xls, xlsx, Max. file size: 10 MB.Processing Statement 2MonthChoose oneJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYearChoose one202220212020Processing StatementAccepted file types: jpg, png, jpeg, gif, pdf, csv, xls, xlsx, Max. file size: 10 MB.Processing Statement 3MonthChoose OneJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYearChoose one202220212020Processing StatementAccepted file types: jpg, png, jpeg, gif, pdf, csv, xls, xlsx, Max. file size: 10 MB.NameThis field is for validation purposes and should be left unchanged.