Merchant Account Pre-Qualification Form
This Merchant Account Pre-Qualification form is not a binding contract for service. Information provided in this form allows our banking partners and merchant services providers to identify the most suitable electronic payment processing solution for the applicant. Information provided in this form is considered private and confidential in nature. Under no circumstances will your information will be sold to nor shared with any outside party that has no direct involvement in the provisioning of service.
Sign in to Google to save your progress. Learn more
Email *
Legal Name of Company
Business Operating Street Address
City & State *
City & State
Postal Zip Code *
Postal Zip Code
Is the postal mailing address the same as physical operating address?
Physical Address (if different from the address provided above)
Website URL domain (www.)
Which Website Builder Do You Use?
Do you sell from a retail store environment that requires credit card processing?
Clear selection
Number of Store Locations or Offices
Primary Business Telephone Number (w/area code)
Telephone Number
Customer Service Telephone Number (w/area code)
Telephone Number
Customer Service Email Address
Type of Business Entity
Business Tax ID Number or SSN
Business Start Date (MM/YYYY)
Gross Yearly Sales Volume (In US Dollars)
Visa & MasterCard  - average monthly processing volume
Discover Card - average monthly processing volume
American Express Card - average monthly processing volume
Electronic Deposit | Bank Account Details: Routing Number (1st) and Account Number (2nd)
Name Listed As Bank Account Holder
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy