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 Terminal Internet Gateway US Based Merchant Account 3rd Party Processing ACH Processing ATM Machines Check Processing Terminal Internet Virtual Terminal Offshore Merchant Account Check Guarantee Check 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:

 Yes No

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.

 Yes No

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