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Forms

Home › Forms › Website Payment Pro Application

Merchant Type:*

New Merchant Add/Multi-Location

Existing MID:

Business Information

DBA Name:

Location Address:

City:

State:

Zip:

Location Tele (#):

Fax (#):

Location Contact Name:

Corporate Name:

Corporate Address:

City:

State:

Zip:

Corporate Tele (#):

Fax (#):

Email Address:

Website Address:

Year Business Established:

Length of Current Ownership:

Years’ Experience:

Services/Products Sold:

Business Structure:

Closely Held Corporation Publicly Traded Corporation Non-Profit Sole Ownership LLC (Disregarded Entity/Corporation/Partnership) Sub-Chapter S Partnership (General/Limited)

Federal Tax ID:

Statements/Retrievals to:

Location Corp Address

Customer Service Tele (#):

Time Zone:

Are Credit Cards Currently Accepted at this Business?:

Yes No

If yes, include statements:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

Have you ever had your merchant account closed?:*

Yes No

Cards currently/to be accepted:

Visa/MasterCard/Discover American Express Debit

Current Amex (#):

Est Monthly Visa/MC/Discover Volume ($):

Avg Sale ($):

High ($):

Low ($):

Method of Processing

Card Present (swipe) %:

Card Present (no swipe) %:

Mail Order %:

Telephone Order %:

Internet %:

Site Survey:

Retail Store Office Building Residence Kiosk Other

Other:

Is there adequate inventory displayed?:

Yes No

Does the name on storefront match the DBA?:

Yes No

Is inventory & merchandise consistent with type of business?:

Yes No

Complete the information below for all principles of the business. Include information for Owners and/or Partners. If it is a Corporation, include President and other Corporate Officers.

Include a minimum of 51% of ownership (unless widely held). Use additional sheets if necessary. Don’t forget the Corporate Resolution.

Ownership Information

Owner #1

Name:

Home Tele (#):

Cell phone (#):

Home Address:

City:

State:

Zip:

Date of Birth:

Social Security (#):

Business Title:

% of Ownership:

Previous address:

Owner #2

Name:

Home Tele (#):

Cell phone (#):

Home Address:

City:

State:

Zip:

Date of Birth:

Social Security (#):

Business Title:

% of Ownership:

Previous address:

Please rate your credit history:

Excellent Good Fair Average Below Average Bad Initial

Have any of the above or the business been a party to any claims or lawsuits?:

Yes No

Have you ever had a merchant account terminated?:

Yes No

Method of Credit Card Processing In/ To Use:

Terminal Software Internet Gateway

Name/Type of Equipment/Software/Gateway:

Supporting Documents

Complete Merchange Application:

1st Document Type:

Voided Business Account Check With DBA Or Legal Entity Name Signed And Dated Bank Letter or Business Account Check With DBA Or Legal Entity Name

Must Include Account and Routing Number

2nd Document Type:

Three Months Of Company Bank Statements (If Existing Business) Three Months Personal Bank Statements (If New Business)

Three Months Processing Statments For All Acconts If Currently Processing Or Processed Recently:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

Driver's License For All Owners / Principal Signers:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

Articles Of Incorporation / LLC:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

EIN Letter From IRS:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

Currently Utility Bill With Business Address:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

Proof Of Domain Ownership:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

URL / Website Must Have Following Listed Below:

Privacy Policy, Refund Policy, Terms & Conditions. Website Must Be Complete With A Published Disclamer Stating website payment pro Has “no Thc” Or No More Then "0.3%" Or Less.

COA (Certificate Of Analysis) For Every Product Sold Online also Known As Lab Result/Test:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.

Export Of All Products Sold On The Website:

Max upload file size 2MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx, .csv, .xls, .xlsx

Website Payment Pro offers secure, long term credit card processing for all industries worldwide.

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