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Terminated Merchant Application

Please fill out the short form below. One of our experts will contact you to complete the quoting process. No term commitment, no cancellation fees, no hidden fees, no obligation.

Business Information
Address Line 1
City
State
Country
Zip code
Use to select a date
DBA (Doing Business As) Information
Corporate Contact Information
Please enter a valid phone number.
Eg.example@example.com
Please enter a valid phone number.
Eg.example@example.com
Primary Owner
Please list all owners who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, own 25% or more of the equity interests of the legal entity listed in this application. Additionally, please ensure the owner(s) below equate to a combined ownership of at least 51%.
First Name
Middle Name
Last Name
Use to select a date
Address & Contact Information
Address Line 1
City
State
Country
Zip code
Please enter a valid phone number.
Eg.example@example.com
2. Principal (Optional)
First Name
Middle Name
Last Name
Use to select a date
Address Line 1
City
State
Country
Zip code
Please enter a valid phone number.
Eg.example@example.com
Bank Account Information
Payment Information
We need a bit of information about your business and how it accepts credit/debit cards.
Who is Your Processor today
Intended Usage