Merchant Onboarding Application

All fields marked are required. Do not use dashes or spaces in numeric fields.

Business Information

Legal Business Name

DBA Name

Business Ownership Type

Federal Tax ID / EIN

Business Phone (with country code)

Primary Business Email

(Physical address only — P.O. Boxes not accepted)

Street Address Line 1

Street Address Line 2

Street Address Line 3

Street Address Line 4

City

State / Region

ZIP / Postal Code

(Each person with 25% or more ownership — up to 4)

First Name

Last Name

SSN or Government-Issued ID

Date of Birth

Residential Street Address

City

State

ZIP / Postal Code