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Now that you have decided to apply for one of our excellent merchant account programs, please complete the below Merchant Application Worksheet. This form is used to gather the information necessary to complete your original Merchant Application. We will transfer the info that you provide to the original app and then fax or email it to you for your signature along with a checklist of any other items that might be required depending upon the program that you have selected.

Business Information

Business Name

Exact Legal Name

Contact Person

Business Address

Business Telephone Number

Business Fax

Federal Tax ID Number

E-Mail Address

Web Site

Type of Ownership

Years In Business (Enter '0' if New)

Owner Information


Residence Address

Date of Birth

Banking Information

Name of Merchant Bank

Contact at Bank

Bank Local Telephone Number

To minimize spam please verify that you are a real person and not a robot. Simply type in the field below the password that you see written to the right.

Required documentation (fax to 215-489-7880 or scan and email to )

  1. Copy of a blank voided check where you want the funds deposited.
  2. Copy of either a Business License, Sales Tax Permit, or Articles of Incorporation.
  3. If already processing credit cards you must fax 2 recent monthly statements.
  4. Please take a photo of the outside sign of your business and an inside photo and text it to 215-530-9688.
  5. We are required by law to attach a Social Security number to each merchant account and will request this info verbally.