Merchant Application Form

For more information, or assistance with a credit card processing merchant account from High Risk Credit Card Processor, please fill out the inquiry form provided below and a High Risk Credit Card Processor representative will contact you within 24 hours.

Email Contact:
info@highriskcreditcardprocessor.com

High Risk Credit Card Processor
877-460-8472
http://www.highriskcreditcardprocessor.com

Fields marked with a * are required.

PRODUCTS / SERVICES

How were you referred to High Risk Credit Card Processor:


 Other

Products/Services you are seeking:

 

 

 

Credit Card TerminalInternet GatewayUS Based Merchant Account3rd Party ProcessingACH ProcessingATM MachinesCheck Processing TerminalInternet Virtual TerminalOffshore Merchant AccountCheck GuaranteeCheck Conversion

BUSINESS INFORMATION

Business Name:

*

Contact Name/Title:

*

  E-mail:

*

Phone:

*

Cell Phone:

Business Address:

City:

State:

Zip:

Country:

Phone:

  Fax:

Website:

ABOUT YOUR BUSINESS

Are you a startup:

YesNo

Age of business:

Products/Services Sold:

How is your product/service sold:

 

Retail Storefront:


%

 

Mail Order:


%

 

Inbound Phone Sales:


%

 

Outbound Telemarketing:


%

 

Internet:


%

 

Total:

100%

 


Current Monthly
Volume: $

 

 

 

Projected Monthly Volume: $

 

 

 

Average Credit Card Transaction: $

 

 

 

Highest Credit Card Transaction: $

 

 

 


Have you ever been terminated

by
a processor before?

If YES, please explain in

comments box below.

YesNo

If so, by what banks/processors?

Who do you currently process with?

(need last 3 months processing statements faxed to us: 702-947-5730)

What banks/processors have you processed with in the past?

Why are you not with them anymore?

Who have you applied with so far?

How is the signers personal credit?

Credit Score:

Comments:

 

 

Contact Us

Please take about 1 minute to complete our NO OBLIGATION quick form and submit it to us. This will allow our team to evaluate your needs and present a banking / pricing solution for your particular business.

 

High Risk Credit Card Processors
Phone: 877-460-8472
info@highriskcreditcardprocessor.com
http://www.highriskcreditcardprocessor.com