Secure Bancard Application Wizard

It takes just minutes to apply!

Please complete the form below. We are here to make sure that your merchant account setup process is prompt and pleasant.
For your privacy and security, your account information is kept safe with the highest grade of commercially available encryption. Your information will be kept completely confidential and will not be shared with anyone under any circumstances.

Contact Information
*First name

*Last name

*Phone number

*Email

Website

Welcome

We look forward to servicing all your transaction processing needs.

The account setup process is fast and easy!

You must have a U.S. business address and a U.S. bank account. Home based business addresses are acceptable.

You will need to have the following information available when completing your application.

Business and personal contact information
Estimated average credit card transaction amount
Estimated monthly credit card sales
Social Security Number
Business Federal Tax ID number (Sole proprietors may use their Social Security Number.)
Checking Account Number (DDA Number) and Bank Transit Routing Number. Have a check nearby for Reference.

Business Location
*Business Address

*Business City

*Business State

*Business Zip Code

Merchant Information
*DBA (Doing Business As) Name

*Legal Name of Business

*Federal Tax ID (Sole Proprietor may use Social Security Number)

(12-1234567 or 123-12-1234)

*Business Start (Example: 02/25/2010)

*State where business formation/incorporation

*Type of Business

*Type of Goods/Services Sold

*Type of Ownership

Please estimate your average ticket and monthly volume amounts.

*Average Ticket Amount
$

(1000.00 - no commas)

*Average Monthly Volume
$

(10000.00 - no commas)

Ownership and Settlement Account
*Owner First Name

*Owner Last Name

*ID Type

*Owner State/Country of Issuance

*Date Issued

*Date Expired

*ID Number

Browse Here for Driver License Image File.
Only .jpg .png and .pdf will be accepted

*Social Security Number

(123-12-1234)

*Date of birth (Example: 02/25/2010)

*Owner Home Address

*Owner Home City

*Owner Home State

*Owner Home Zip

*Owner Phone Number

*Ownership Percentage

Where should we deposit your money?

*Bank Name

*Bank Routing Number

*Bank Account Number

Browse Here for Void Check Image File.
Only .jpg .png and .pdf will be accepted

Is there another owner that owns more than 25% of the business? Yes | No

Beneficiary 2
*Beneficiary 2 First Name

*Beneficiary 2 Last Name

*Beneficiary 2 Home Address

*Beneficiary 2 Home City

*Beneficiary 2 Home State

*Beneficiary 2 Owner Home Zip

*Beneficiary 2 Phone Number

*Beneficiary 2 Title

*Beneficiary 2 percentage(Current sum: 0%)

*Beneficiary 2 Date of birth (Example: 02/25/2010)

*Beneficiary 2 Social Security Number

(123-12-1234)

*Form of id:

*Beneficiary2 number:

*Beneficiary2 expiration:

*Beneficiary2 Issuer State:

*Beneficiary2 Issued Date (Example: 02/25/2010)

Is there another owner that owns more than 25% of the business? Yes | No

Beneficiary 3
*Beneficiary 3 First Name

*Beneficiary 3 Last Name

*Beneficiary 3 Home Address

*Beneficiary 3 Home City

*Beneficiary 3 Home State

*Beneficiary 3 Owner Home Zip

*Beneficiary 3 Phone Number

*Beneficiary 3 Title

*Beneficiary 3 percentage(Current sum: 0%)

*Beneficiary 3 Date of birth (Example: 02/25/2010)

*Beneficiary 3 Social Security Number

(123-12-1234)

*Form of id:

*Beneficiary3 number:

*Beneficiary3 expiration:

*Beneficiary3 Issuer State:

*Beneficiary3 Issued Date (Example: 02/25/2010)

Is there another owner that owns more than 25% of the business? Yes | No

Beneficiary 4
*Beneficiary 4 First Name

*Beneficiary 4 Last Name

*Beneficiary 4 Home Address

*Beneficiary 4 Home City

*Beneficiary 4 Home State

*Beneficiary 4 Owner Home Zip

*Beneficiary 4 Phone Number

*Beneficiary 4 Title

*Beneficiary 4 percentage(Current sum: 0%)

*Beneficiary 4 Date of birth (Example: 02/25/2010)

*Beneficiary 4 Social Security Number

(123-12-1234)

Form of id:

Beneficiary4 number:

Beneficiary4 expiration:

*Beneficiary4 Issuer State:

*Beneficiary4 Issued Date (Example: 02/25/2010)

** By Federal Law, All Information Provided Will Remain Confidential **