We’re on to Step 2!

We have found a processor for you! Approval will still require underwriting and additional documentation. After you complete this form your agent will send you a unique secure link to upload the required documentation needed to submit to underwriting. This information will be entered on the completed merchant application with the rates and fees. That will be provided after all needed documents are submitted. If you do not have those docs ready please do not submit this form until you are ready. This application is on a secure 256 bit encryption page for your security.

*If you were not referred by an agent please put "PayHouse Direct".
*If different than Legal Business Name.
*Enter from the time of when you registered the business under the legal business name.
If you have multiple websites separate by commas.
Enter your TIN used to pay your taxes.
All card acceptance method % must equal up to 100%.
All card acceptance method % must equal up to 100%.
All card acceptance method % must equal up to 100%.
*Recurring charges are automated payments on an ongoing basis.
*You must have all these on your website completed before submission. DO NOT go any further if this is not completed already.
(ex. 03-13-1969)
*This is require to verify proof of identity. (ex. 333-33-3333)
*Abbreviate state (ex. IL, FL, CA, etc...)
*Legal name on the bank account.
*This website is secured by a 256 bit encrpytion and your data is protected.
*All banking information will need to be verified by bank letter or bank statements.
If your company uses a CRM to track sales enter it here. Leave blank if not applicable.
*If you are on the MATCH list you should have been notified by the processor or sponsoring bank. This will not disqualify you for processing.
Your agent will send you a secure upload link to submit all required documents within 24 hrs of submission.
*The person submitting this form must sign here and is validating that all information is accurate and truthful. Any inaccurate information may disqualify you or change the initial processing quote. By signing this, this does commit you to any offer we may propose. That step will be in the final agreement.
Our website uses a secure SSL 256 bit encryption to protect your data. We do not sell or share your information with unrelated third parties. We will never spam you. This is for internal purposes only.