Business Info Owner Details Banking Documents Submit

Merchant Application

Please complete the details below to start your merchant account.

Secure Encryption

1 Business Information

Legal Business Name *

DBA Name (Signage) *

Federal Tax ID (EIN) *

Business Phone *

Business Email *

Website (Optional)

Business Start Date

Business License State

Timezone

Ownership Type

Business Type *

Detailed explanation of the merchandise and/or services sold/performed by the merchant *

Business Location Type *

Other Business Location Type *

Approximate Square Footage *

Average Monthly Volume

Average Ticket Amount

Auto batch close

Auto batch close time

Card Acceptance *

Credit cards Debit cards EBT

FNS Number *

Business Address *

Unit / Suite #

City *

State *

Zip Code *

Address Information

Mailing Address is same as Business Address

Mailing Street Address *

Mailing Unit / Suite #

Mailing City *

Mailing State *

Mailing Zip Code *

Contact Information

Contact Name *

Contact Email *

Contact Phone *

Mode of Transaction

Enter the percentage of transactions by channel. Must total 100%.

In Person % *

Telephone % *

Online % *

Total: % — must equal 100%

Do you use any third party to store, process, or transmit cardholder data? *

Examples include but are not limited to web hosting companies, Electronic Data Capture, loyalty programs.

Yes No

Third Party Details *

2 Owner Information

Federal law requires us to verify the identity of any person with 25% or more ownership.

First Name *

Last Name *

Title *

Social Security Number *

Date of Birth *

Phone and email same as business

Owner Phone *

Owner Email *

Ownership Percentage *

Owner % total must equal 100%

Owner Mobile Phone *

Driver's License Number *

Driver's License State *

Residence Address

Street Address *

Unit / Suite #

City *

State *

ZIP Code *

Country

Additional owners

Total ownership: % (primary owner). Add owners below if needed; total must equal 100%.

Total: % (must equal 100%)

3 Deposit Account

Bank Name *

Routing Number *

Account Number *

4 Upload Documents

Voided Check

Drag & drop or click to upload

Uploading...

Driver's License

Drag & drop or click to upload

Uploading...

I certify that the information provided is true and correct, and I authorize Peachcrest Payment Solutions to pull my personal credit report for underwriting purposes.

Your data is encrypted and sent directly to our underwriting team.