Merchant Account Application              

 

INSTRUCTIONS:

 

Step 1.  You may either complete the information required below and send by “Clicking” the “Send Information” Button Or you may print this form and mail to; American Payment Exchange, 256 Garner Dr, Mabank Texas, 75156.

 

Step 2.  The Merchant Account Agreement and other required forms will be completed by our office using the information you provide.  The completed Merchant Account Agreement and other forms will be sent by Priority U.S. Postal Mail Service for your review and signature.

 

 

Step 3.  Sign the completed Merchant Account Agreement and other forms in the spaces where marked.  Return by U.S. Postal Service the completed and signed Merchant Account Agreement, other signed forms and other required underwriting documentation.   

 

See Underwriting Documents Required: 

 

    A.  Merchant Credit Card Processing Account Documents Required

    B.  Merchant Check Processing Account Documents Required

 

 

Note:  Be sure ALL required signatures and underwriting documents are complete.  Missing information or missing signatures will cause Approval Delays. 

 

 

Step 4.  Allow 2-5 business days after complete information is received at our office for underwriting approval.  You will be notified by email or fax when approval is given. 

 

Once approval is given, you may set-up check processing equipment and implement check processing.  If new check processing equipment is needed, you may purchase equipment here.  Order Equipment

 

 

Complete Merchant Account Application:

 

Select Each Type Processing Being Applied For:

 

 

Credit Card - Details - All merchants over $10,000.00 per month card volume or over $500.00 per transaction.  Include e-Merchantview reporting

 

Online Electronic Checks  - Details - For accepting check payments online

 

Checks By Phone - Details - For accepting check payments by phone

 

Visa POS Check Services - Details - For Electronic Check Verification/Conversion at point-of-sale

 

Recurring Payments - Details - For accepting Automated Scheduled Payments by check or credit card

 

Consumer Check Acceptance Verification - Details - For verification of consumer check presenter's check

 

Payroll Check Cashing Verification Services - Details - For verification of payroll checks

 

Wireless Remote Check And/Or Credit Card Processing - Details - For delivery & outside sales people equipped with cell phone or laptop wireless processing device 

 

FREE Check Re-Presentment & Collection Services - Details - For returned check re-presentment & collection of checks full face value

 

FREE Check Guarantee Small Ticket Program - Details - For checks $25 or less

 

Pre-paid Card Reseller Program - Details - For merchant resellers wanting to sell a full line of pre-paid card products on consignment 

 

 

Legal Business or Corporate Name:

 

Legal Business Street Address: 

 

City: State: Zip:

 

Billing Address: 

 

City: State: Zip:

 

Business Phone: Fax: 

 

Web Site URL: 

 

Email Address:

 

Type Of Business Structure (Select One): Sole Proprietorship   Partnership   LLC 

 

Corporation

 

Age Of Business: Years       Date Business Was Acquired:

 

Type Of Business:     

 

Type Of Products Or Services offered:

 

Business Federal Tax ID Number:

 

Primary Contact Person (First, Last Name & Title):

 

Primary Contact Phone Number: 

 

Primary Contact Email Address:

 

Doing Business As Name:

 

DBA Storefront Street Address: 

 

City: State: Zip:

 

Do You Have Multiple Storefront Locations?           Yes            No         

 

If Yes, How Many Locations?

 

For Multiple Locations, Please Provide Required Information On Multiple Location List.

 

Complete the following information if application is for any Check Services.

 

NUMBER OF CHECKS:     

 

Average # Per Day:   Maximum # Per Day:

 

DOLLAR AMOUNT PER CHECK: 

 

Average Amount:     Maximum Amount:

 

TOTAL DOLLAR AMOUNT OF CHECKS: 

 

Average Per Month              Daily Maximum:

 

Complete the following information if application is for Credit Card Services.

 

NUMBER OF Credit Card Transactions:     

 

Average # Per Day:   Maximum # Per Day:

 

DOLLAR AMOUNT PER CREDIT CARD TRANSACTION: 

 

Average Amount:     Maximum Amount:

 

TOTAL DOLLAR AMOUNT OF CREDIT CARDS: 

 

Average Per Month              Daily Maximum:

 

TYPE OF CARD TRANSACTIONS:

 

Percent of Swipe Transactions:    Percent of Online Transactions :

 

 

Percent of Phone Transactions:    Percent of Keyed Transactions :

 

 

BANK DEPOSIT INFORMATION:

 

Bank Name: 

 

Bank Contact: Contact Phone #:

 

Bank Address: 

 

City: State: Zip:

 

Bank Routing #:           

 

Bank Account #:

 

BUSINESS OWNER / OFFICER INFORMATION:

 

President Or Owner’s Name / Title:  

 

Equity % Ownership:Social Security #:          

 

Date Of Birth:        Age:

 

Residence Address: 

 

City: State: Zip:

 

How Long At Address:        Own       Rent     

 

Home Phone:

 

Second Officer Or Co-Owner’s Name Title:    

 

Equity % Ownership:Social Security #:          

 

Date Of Birth:        Age:

 

Residence Address: 

 

City: State: Zip:

 

How Long At Address:        Own       Rent     

 

Home Phone:

 

STOREFRONT SITE SURVEY:

 

Type Of Building: Shopping Center  Office Building  Residence  Storefront 

 

Other  

 

Area Zoning:  Commercial       Industrial             Residential         

 

Square Footage: 0 -250        250 - 500           500 - 2,000       2,000 Plus

 

Is The Amount Of Inventory At The Location Consistent With The Type Of Business And Projected Sales

 

Volume? Yes  No

 

If "No" explain:

 

Survey Overall Comments:



For security, please perform the following:

 

1. Pass your mouse over each photo below and "Click" one time on each "Cat" photo

2. After you have selected each cat photo, "Click" on the "Submit Information" bar.

 

If you need help, please contact us at 903-451-9590

between 8:00 A.M. - 5:00P.M. CST Monday - Friday.

 

 

 

     

 

 

 

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© December 2005 American Payment Exchange LLC