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Merchant Application

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MERCHANT APPLICATION

DBA (what will appear on customer’s statement)

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Company phone

Sales page URL

Customer service phone number

Customer service email address

Legal Business Name (as it appears on tax return)

Legal address, if different

Contact person (if questions on account)

Contact person’s email

Business Profile

Business Structure (corporation, LLC, sole prop.)

Date business formed & state

Number of employees

Federal Tax ID

Site Survey

Office Structure (Office, Residential, Industrial, etc)

Approximate square footage

Building Ownership

Owner/Officer

Owner’s Name

Owner’s Title

Owner’s Ownership %

Social Security #

Date of Birth

Mobile Number

Home Address

Driver’s License number and State

Email address

Product Price Info

Projected monthly volume

Average ticket

High ticket

Describe product/service in detail

Refund policy

Transaction type (swiped, mail/phone, internet) – must equal 100% if multiple types

% of Business to Consumer sales

% of Business to Business sales

Current Account Profile

Do you currently accept V/MC/D?

Do you currently accept AmEx?

If not currently accepting AmEx, do you want to?

Name of current Processor

Gateway you are currently using

Bank Information

Bank Name

Account #

Routing #

Is this a checking or savings account?

Offer Information

How long until the customer receives the product?

What are the price points for the product/service?

Is there a free trial and/or auto ship program attached to the product/service?

Is there recurring billing/continuity plan associated with the product/service?

How is the product/service advertised, marketed, and/or promoted? (i.e. radio, print, affiliate networks, CPA, publishers, and/or other sources)

What is the warranty, return, and refund policy?

Is fulfillment handled In House or outsourced? If outsourced, with whom?

Who manufactures/produces the product/service?

Is Customer Service handled In House or outsourced? If outsourced with whom?

How do you want the billing descriptor to read on customer's statements? (22 characters max, includes spaces)

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Declines.io

Converting payment declines into increased revenue.

Contact

+1-844-333-2546
admin@declines.io
3168 Redwood Street, Las Vegas, NV 89146

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