ISO INFORMATION - Valued Merchant Services
MERCHANT PROCESSING GENERAL APPLICATION
|BUSINESS INFORMATION |
|Corporate Information |State/Country Filed: |
| Sole Prop Partnership Public Corp. Private Corp. LLC | |
|Legal Name: |Business Telephone: |Business Fax: |
| | | |
|Business Name (DBA): |Website Address: |
| | |
|Contact Name: |Contact E-Mail: |
| | |
|Cardholder Descriptor: (21 characters max.) |Business Start Date : |Federal Tax ID: |
| | | |
|Description of Products/Services: |
| |
|OWNERS/PARTNERS/OFFICERS (OWNERSHIP MUST TOTAL 50%) |
|Name: |Title: |Equity / Ownership%: |
| |
|Date of Birth: |Driver’s License & State / Passport # |Social Security # |
| | | |
|Home Address: |City / State / Zip Code |Home Telephone: |
| | | |
|Name: |Title: |Equity / Ownership%: |
| |President | |
|Date of Birth: |Driver’s License & State / Passport # |Social Security # |
| | | |
|Home Address: |City / State / Zip Code |Home Telephone: |
| | | |
|MERCHANT PROFILE |
|Which do you currently accept? |Name of previous processor: |Ever been listed on the Terminated Merchant File? |
|(check all that apply) | | |
| Visa MasterCard Discover | | No Yes, provide date |
|American Express None | | |
|Equipment Type: |Accepted Currencies: |Merchant Account Type: |
| Gateway: New Account Existing | USD BPD | Domestic International |
|Terminal Make & Model: |EUR Other: CND (Canadian) | |
|Describe your refunding policy: |Seasonality: |
| | J F M A M J J |
| |A S O N D 1 none |
|Processing Volume for Visa/MC/Discover: |Where are Sales Transacted? |How are Sales Transacted? |
| Average Monthly Volume | Store Front/ face- face % | Electronic Data Capture/Swipe % |
|Average Ticket |Internet % |Manual Entry, no card present % |
|Highest Avg. Ticket |MOTO % |Voice Authorization & Capture % |
| |Other % |Other % |
| |Total Must Equal 100% |Total Must Equal 100% |
|MOTO/ CARD NOT PRESENT / B2B Information |
| What percentage of total sales represent Business to Business: B2B % B2C % = 100% (total sales) |
|What percentage of bankcard sales represent Business to Business: B2B % B2C % = 100% (total sales) |
|What is the time from transaction to deliver? (% of orders delivered in days) 0-7 % 8-14 % 15-30 % 30+ % = 100% |
|Visa/MasterCard/Disc sales are deposited on: Date of Order Date of Delivery Other |
This application will be used solely for the purpose of pre-approval. Please include the following 3 months processing statements, 3 months bank statements, copy of driver’s license, current P&L, 2 years tax returns, Articles of Incorporation. Once this application is completed, please send via email to sales@ or via fax to 877-885-1740.
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