Full Merchant ApplicationFill out our full merchant application and upload documents First NameLast NameYour EmailYour Phone Company Profile Company NameDBA / Trading Name (if different from Company Name)Company Street AddressCompany City, State, Postal, CountryCountry of Incorporation—Please choose an option—AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofColombiaComorosCongoCook IslandsCosta RicaCote d'lvoireCroatiaCubaCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambia, TheGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern CyprusNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint-BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Director Profile Name of Primary DirectorDirector Street AddressDirector City, State, Postal, CountryDirector EmailDirector Phone Business Profile Description of products or servicesWeb Site URL(s)Test UsernameTest PasswordCustomer Support NumberCustomer Support EmailMethod of Acceptance (total must add up to 100%)% Web / online sales (e-commerce) % MOTO / call center % Point of Sale (Retail)Target Markets (total must add up to 100%)% USA & Canada % Europe & UK % Asia % Latin America % OtherDo you need credit card processing? —Please choose an option—YesNoDo you currently accept credit cards? —Please choose an option—YesNoHow long have you been accepting credit cards?Current Payment Service Provider(s)Reason for ChangeMonthly Credit Card Total Sales Volume(If you are a startup, please use projected figures)USDEURGBPAverage Single TransactionUSDEURGBPHighest Single TransactionUSDEURGBPDo you need eCheck (ACH) processing? —Please choose an option—YesNoDo you currently accept eChecks? —Please choose an option—YesNoHow long have you been accepting eChecks?Current Payment Service Provider(s)Reason for ChangeMonthly eCheck Total Sales Volume (in USD)(If you are a startup, please use projected figures)USD Average Single TransactionUSD Highest Single TransactionUSD Do you need SEPA direct debit processing? —Please choose an option—YesNoDo you currently accept SEPA direct debit? —Please choose an option—YesNoHow long have you been accepting SEPA direct debit?Current Payment Service Provider(s)Reason for ChangeMonthly SEPA Direct Debit Total Sales Volume (in EUR)(If you are a startup, please use projected figures)EUR Average Single TransactionEUR Highest Single TransactionEUR Do you need local payments processing? —Please choose an option—YesNoWhich Countries/Regions are you looking for local payments processing for?Monthly Local Payments Total Sales Volume(If you are a startup, please use projected figures)USDEURGBPAverage Single TransactionUSDEURGBPHighest Single TransactionUSDEURGBPDo you need cryptocurrency processing? —Please choose an option—YesNoMonthly Cryptocurrency Total Sales Volume(If you are a startup, please use projected figures)USDEURGBPAverage Single TransactionUSDEURGBPHighest Single TransactionUSDEURGBPAdditional Comments (special requirements, shopping cart or CRM platform used, etc)To help us work on your merchant account without delay, please click Submit below and use the Document Uploader in the next step of the application. Thank you!Δ
