Apply Now for A Merchant AccountFill out the form below and we will be in touch with you! Name * First Name Last Name Email * Phone * (###) ### #### DBA DBA Address DBA City, State, Zipcode Business Legal Name Business Legal Address Federal Tax ID When did you open your business? (mm/yy) What state is your business registered in? What % of your sales are swiped/inserted? What % of your sales are keyed in manually? Do you take E-commerce payments? Visa/Mastercard/Discover monthly sales volume? What is the highest sale you will run? How many high sales will you have per year? American Express monthly sales volume? American Express average ticket? Signor's Name Signor's Title Signor's Ownership % Signor's Cell Phone Number? Signor's Home Address Signor's Date of Birth (mm/dd/yy) Signor's SSN What product/services do you provide? What's your business type? (sole proprietorship, LLC, S-Corp?) What's your business type? Website http:// Who brought you to Certain Pay? What is your annual gross business volume? What is your annual credit card volume? What is your average charge amount? What is your highest charge you will need to process? When are your credit card sales deposited? Date of order Date of delivery What is your refund policy? No refunds Exchange only Full refund Store credit What is your time frame for delivery of product? 0-7 days 8-15 days 16-30 days 30+ days Thank you so much! We will be in touch shortly!
