Online Merchant Account Application

Merchant Account Application

Just complete the Online Application below and click the "Submit" button.

Upon receipt, we'll transfer this information to the appropriate hard-copy documents and send them to you, already completed for you to sign and return with the following items:

     • "Void" Check from Business Checking Account
     • Pictures of Business Location (Inside / Outside)
     • Copy of Business Certificate (if no permanent sign on business location)
     • Copy of Driver's License
     • Copies of last three (3) month's card processing statements (if you accept cards now)
     • Marketing Material, Business Card, Website Address, etc.
     • Application Fee Payable to FAPS
     • First & Last Lease Payment or Purchase Payment payable to FAPS

If you will be processing over $50,000 per month we will also require:

     • Most recent financial statements (profit / loss and balance sheet)
     • Copies of last two (2) years tax returns (business and personal)
     • Copies of last two (2) month's business checking account statements

We will then process your application, and on approval, usually within a few business days, send your terminal, software or Internet gateway set up instructions so you can start accepting credit cards right away... It's that simple!

You can also call us toll free at (800) 258-8028 if you have any questions or to submit your application over the phone. If you get our voice mail, please leave your name, number, and best time to call. We'll get back to you ASAP.

NOTE: If your browser does not support forms or you experience any difficulty, please "Print Form" and complete accordingly, then fax to (845) 774-7481. Thank you.

Principal Contact Name

Title

Phone Number

Fax Number

E-mail Address

Website Address (if applicable)

Legal Business or Corporate Name

"Doing Business As" Name

Location Address

City, State, Zip Code

Billing Address (if different from location)

City, State, Zip Code

Nature of Business (be specific)

Estimated % of Swiped Transactions %
Estimated % of Keyed Transactions with Imprint %
Estimated % of Keyed Transactions with No Imprint %
(ie: Mail, Telephone, Internet, Fax orders)
NOTE: All three numbers should equal 100%

Monthly Bankcard Volume (estimate)
Average Ticket (estimate)

Years in Business Date Acquired
Federal Tax ID Number
State Sales Tax ID Number

Type of Business Entity (please check one)

Sole Proprietorship Partnership
Corporation Not for Profit

President's / Owner's Name

Title
Social Security Number
Date of Birth
Residence Address
City, State, Zip
How Long at this Residence? Own Rent
Home Phone
Previous Address (if at current less than 3 years)

Second Officer / Owner Name (if applicable)

Title
Social Security Number
Date of Birth
Residence Address
City, State, Zip
How Long at this Residence? OwnRent
Home Phone
Previous Address (if at current less than 3 years)

Trade Name
Phone number
Contact

Trade Name
Phone Number
Contact

Terminal Software Internet Gateway
Please Specify Type

Will this be... Purchase Lease

Additional Comments:

Referred By

PLEASE PRINT COPY FOR YOUR RECORDS
BEFORE SUBMITTING !!