Merchant Application
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Social Security number MUST match Contact Name.
Bank Information
Authorized Signer
Date Of Birth
(use format MM-DD-YYYY)
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Select Industry
Accounting
Acupuncturist
Agriculture
Airport
Amusement Park
Aquarium
Art Gallery
Atm
Auto Dealership - Sales
Auto Dealership -Parts/Service
Automotive - Detailing
Automotive - Service
Automotive - Service/Repair
Automotive - Tires
Bakery
Bank
Bar
Beauty Salon
Bike Repair
Billing
Blood Donations
Book Store
Broadband
Business Services
Cafe
Call Center/Answering Service
Car Rental
Cbd
Cemetery
Children Play Center
Chiropractor
Church Events
Churches
Clinical Testing
Clothing Store
Coach - Athletics
Coach - Business
Coach - Life
Collections
Computer Repair
Consulting
Convenience Store
Counselor
Court Reporting
Day Care
Day Spa
Delivery/Dock
Dentist
Department Store
Diet/Nutrition/Weight Loss
Dietitian/Nutritionist
Dispensary
Doctor - Acupuncture
Doctor - Chiropractor
Doctor - Dermatologist
Doctor - Ears, Nose And Throat
Doctor - Eyes
Doctor - General Practitioner
Doctor - Obgyn
Doctor - Other
Doctor - Surgeon
Driving School
Dry Cleaner/Laundry
Education - School/District
Electronics Store
Entertainment
Establishment
Events
Exercise/Dance Studio
Exterminator
Financial Advisor
Fire Station
Florist
Flu Shots
Food
Formal Wear
Funeral Home
Furniture Store
Gas Station
General Contractor
Government - Federal
Government - Local
Government - State
Hardware Store
Health
Health And Wellness Products
Health Club
Home Goods Store
Home Services - Ac/Heating
Home Services - Carpeting
Home Services - Cleaning
Home Services - Decks
Home Services - Electrician
Home Services - Flooring
Home Services - Gutters
Home Services - Kitchens
Home Services - Lawn Sprinklers
Home Services - Other
Home Services - Painting
Home Services - Plumbing
Home Services - Repair/Handyman
Home Services - Roofing
Home Services - Turf
Home Services - Windows
Hospital
Hostel
Hotel Service
Hypnosis Center
Insurance Agency
Interpretor
Interview Scheduling
Jewelry Store
Landscape/Lawn Care Maintenance
Laser Weight Loss/Smoking
Law Office
Lessons - Golf
Lessons - Music
Lessons - Other
Lessons - Swimming
Limo Service
Liquor Store
Locality
Locksmith
Magician
Massage Therapist
Meal Preparation
Meal Takeaway
Medical Service
Medical Spa
Meetings
Mind/Bodywork/Other Practitioner
Mosque
Movie Theater
Moving Service
Museum
Night Club
Non-Profit
Notary
Other
Park
Parking
Payment Gateway
Payment Iso
Payment Processor
Personal Services
Personal Trainer
Personal/Virtual Assistant
Pest Control
Pet Groomer
Pet Groomer - Mobile
Pet Services - Other
Petsitting
Pharmacy
Photography Studio
Physical Therapist
Physiotherapist
Political Action Committee (Pac)
Post Office
Professor/Teacher
Property Management
Psychic/Numerologist/Clairvoyant
Real Estate - Escrow
Real Estate - Home Appraiser
Real Estate - Home Inspector
Real Estate - Lender
Real Estate - Realtor/Broker
Rehabilitation/Therapy
Rentals
Research Studies
Restaurant
Retail
Room Reservations
Salon - Hair And Nails
Salon - Hair, Nails, And Tanning
Salon - Nails Only
Salon - Other
Salon - Tanning Only
Salon/Barber Shop - Hair
Seminars
Seminars/Workshops
Shoe Store
Shopping Mall
Skin Care/Facials
Software/Technology
Speech/Occupational Therapy
Spinning Classes
Sporting
Sports Fields
Stadium
Staff Scheduling
Synagogue
Tax Preparer/Advisor
Technical Support
Tennis Courts/Other Courts
Tips
Tours
Training
Travel Agency
Tutoring
University
Utilities
Veterinarian
Virtual Assistant Staffing Company
Virtual Doctor
Visas
Volunteer
Wellness Programs
Zoo
Select Tax Type
Sole Proprietor
Corporation
Partnership
LLC
Non-Profit
Select Business State
AL - ALABAMA
AK - ALASKA
AZ - ARIZONA
AR - ARKANSAS
CA - CALIFORNIA
CO - COLORADO
CT - CONNECTICUT
DE - DELAWARE
DC - DISTRICT OF COLUMBIA
FL - FLORIDA
GA - GEORGIA
HI - HAWAII
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
IA - IOWA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
ME - MAINE
MD - MARYLAND
MA - MASSACHUSETTS
MI - MICHIGAN
MN - MINNESOTA
MS - MISSISSIPPI
MO - MISSOURI
MT - MONTANA
NE - NEBRASKA
NV - NEVADA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NY - NEW YORK
NC - NORTH CAROLINA
ND - NORTH DAKOTA
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VT - VERMONT
VA - VIRGINIA
WA - WASHINGTON
WV - WEST VIRGINIA
WI - WISCONSIN
WY - WYOMING
Select Main Shareholder's State
AL - ALABAMA
AK - ALASKA
AZ - ARIZONA
AR - ARKANSAS
CA - CALIFORNIA
CO - COLORADO
CT - CONNECTICUT
DE - DELAWARE
DC - DISTRICT OF COLUMBIA
FL - FLORIDA
GA - GEORGIA
HI - HAWAII
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
IA - IOWA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
ME - MAINE
MD - MARYLAND
MA - MASSACHUSETTS
MI - MICHIGAN
MN - MINNESOTA
MS - MISSISSIPPI
MO - MISSOURI
MT - MONTANA
NE - NEBRASKA
NV - NEVADA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NY - NEW YORK
NC - NORTH CAROLINA
ND - NORTH DAKOTA
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VT - VERMONT
VA - VIRGINIA
WA - WASHINGTON
WV - WEST VIRGINIA
WI - WISCONSIN
WY - WYOMING
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Industry
Other
Accounting
Acupuncturist
Agriculture
Airport
Amusement Park
Aquarium
Art Gallery
Atm
Auto Dealership - Sales
Auto Dealership -Parts/Service
Automotive - Detailing
Automotive - Service
Automotive - Service/Repair
Automotive - Tires
Bakery
Bank
Bar
Beauty Salon
Bike Repair
Billing
Blood Donations
Book Store
Broadband
Business Services
Cafe
Call Center/Answering Service
Car Rental
Cbd
Cemetery
Children Play Center
Chiropractor
Church Events
Churches
Clinical Testing
Clothing Store
Coach - Athletics
Coach - Business
Coach - Life
Collections
Computer Repair
Consulting
Convenience Store
Counselor
Court Reporting
Day Care
Day Spa
Delivery/Dock
Dentist
Department Store
Diet/Nutrition/Weight Loss
Dietitian/Nutritionist
Dispensary
Doctor - Acupuncture
Doctor - Chiropractor
Doctor - Dermatologist
Doctor - Ears, Nose And Throat
Doctor - Eyes
Doctor - General Practitioner
Doctor - Obgyn
Doctor - Other
Doctor - Surgeon
Driving School
Dry Cleaner/Laundry
Education - School/District
Electronics Store
Entertainment
Establishment
Events
Exercise/Dance Studio
Exterminator
Financial Advisor
Fire Station
Florist
Flu Shots
Food
Formal Wear
Funeral Home
Furniture Store
Gas Station
General Contractor
Government - Federal
Government - Local
Government - State
Hardware Store
Health
Health And Wellness Products
Health Club
Home Goods Store
Home Services - Ac/Heating
Home Services - Carpeting
Home Services - Cleaning
Home Services - Decks
Home Services - Electrician
Home Services - Flooring
Home Services - Gutters
Home Services - Kitchens
Home Services - Lawn Sprinklers
Home Services - Other
Home Services - Painting
Home Services - Plumbing
Home Services - Repair/Handyman
Home Services - Roofing
Home Services - Turf
Home Services - Windows
Hospital
Hostel
Hotel Service
Hypnosis Center
Insurance Agency
Interpretor
Interview Scheduling
Jewelry Store
Landscape/Lawn Care Maintenance
Laser Weight Loss/Smoking
Law Office
Lessons - Golf
Lessons - Music
Lessons - Other
Lessons - Swimming
Limo Service
Liquor Store
Locality
Locksmith
Magician
Massage Therapist
Meal Preparation
Meal Takeaway
Medical Service
Medical Spa
Meetings
Mind/Bodywork/Other Practitioner
Mosque
Movie Theater
Moving Service
Museum
Night Club
Non-Profit
Notary
Other
Park
Parking
Payment Gateway
Payment Iso
Payment Processor
Personal Services
Personal Trainer
Personal/Virtual Assistant
Pest Control
Pet Groomer
Pet Groomer - Mobile
Pet Services - Other
Petsitting
Pharmacy
Photography Studio
Physical Therapist
Physiotherapist
Political Action Committee (Pac)
Post Office
Professor/Teacher
Property Management
Psychic/Numerologist/Clairvoyant
Real Estate - Escrow
Real Estate - Home Appraiser
Real Estate - Home Inspector
Real Estate - Lender
Real Estate - Realtor/Broker
Rehabilitation/Therapy
Rentals
Research Studies
Restaurant
Retail
Room Reservations
Salon - Hair And Nails
Salon - Hair, Nails, And Tanning
Salon - Nails Only
Salon - Other
Salon - Tanning Only
Salon/Barber Shop - Hair
Seminars
Seminars/Workshops
Shoe Store
Shopping Mall
Skin Care/Facials
Software/Technology
Speech/Occupational Therapy
Spinning Classes
Sporting
Sports Fields
Stadium
Staff Scheduling
Synagogue
Tax Preparer/Advisor
Technical Support
Tennis Courts/Other Courts
Tips
Tours
Training
Travel Agency
Tutoring
University
Utilities
Veterinarian
Virtual Assistant Staffing Company
Virtual Doctor
Visas
Volunteer
Wellness Programs
Zoo
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State
AL - ALABAMA
AK - ALASKA
AS - AMERICAN SAMOA
AZ - ARIZONA
AR - ARKANSAS
CA - CALIFORNIA
CO - COLORADO
CT - CONNECTICUT
DE - DELAWARE
DC - DISTRICT OF COLUMBIA
FL - FLORIDA
GA - GEORGIA
GU - GUAM
HI - HAWAII
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
IA - IOWA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
ME - MAINE
MD - MARYLAND
MA - MASSACHUSETTS
MI - MICHIGAN
MN - MINNESOTA
MS - MISSISSIPPI
MO - MISSOURI
MT - MONTANA
NE - NEBRASKA
NV - NEVADA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NY - NEW YORK
NC - NORTH CAROLINA
ND - NORTH DAKOTA
MP - NORTHERN MARIANA ISLANDS
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
PR - PUERTO RICO
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UM - UNITED STATES MINOR OUTLYING ISLANDS
UT - UTAH
VT - VERMONT
VI - VIRGIN ISLANDS, U.S.
VA - VIRGINIA
WA - WASHINGTON
WV - WEST VIRGINIA
WI - WISCONSIN
WY - WYOMING
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USA
CANADA
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