Apply for Credit Card Processing

MERCHANT APPLICATION WORKSHEET

Please provide the following information for fastest service. Please also include a voided check, SS4 document, and last 3 months processing statements (if available). If the below business has been purchased from another ownership currently using TalusPay, please provide a purchase agreement.
Please fill out COMPLETELY to avoid any delays.

DBA Name

Legal Business Name

DBA Address & Legal Address (if different, NO P.O. BOX)

DBA Phone

DBA Email

Business Formation Date

Type of Business Formation

Tax ID # (EIN)

Website

Authorization Passcode (can be used for verification w/support)

Product/Services Description

Any owner/officer greater than 25% must be listed separately. ALL Authorized Signers must include SSN/DOB. If Authorized Contact only, please list below as well as ownership 0%. (you may choose to not include SSN/DOB for an Authorized Contact ONLY).

Full Legal Name (Owner 1)

Residential Address (NO P.O. Box)

SSN

DOB

Personal Phone

% Ownership

Email Address

Title (owner, President, etc)

If the company has more owners, complete the following information

Full Legal Name (Owner 2)

Residential Address (NO P.O. Box)

SSN

DOB

Personal Phone

% Ownership

Email Address

Title (owner, President, etc)

If the company has more owners, complete the following information

Full Legal Name (Owner 3)

Residential Address (NO P.O. Box)

SSN

DOB

Personal Phone

% Ownership

Email Address

Title (owner, President, etc)

If the company has more owners, complete the following information

Full Legal Name (Owner 4)

Residential Address (NO P.O. Box)

SSN

DOB

Personal Phone

% Ownership

Email Address

Title (owner, President, etc)

Annual Credit Card Volume (V/MC/DS)

Annual Credit Card Volume (AMEX)

Average Credit Card Ticket (V/MC/DS)

Average Credit Card Ticket (AMEX)

High Ticket Amount

AMEX ESA (separate AMEX acct)

If YES, ESA Number

EBT

If YES, FNS Number

Transaction Information (% needs to equal 100%. Approximate values)

Swiped

Hand Keyed

On YOUR website

Credit Banking

Routing Number

Bank Name

Account Number

Debit Banking (if different)

Routing Number

Bank Name

Account Number

Only complete if getting equipped with a terminal

Business Type

Communication

Tips

Batch (if Auto, add batch time)

Auto Batch Time (w/time zone)

Owner 1 (Signature)

Owner 2 (Signature)

Owner 3 (Signature)

Owner 4 (Signature)

+ 0

SPECIALISTS

WAITING FOR YOU

+ 0

HOURS

TO FUNDING

Nearly immediate access to our customized financial solutions you need to run and grow your business

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