MaxYourPayments Merchant Services Application Form

Fill out the form below and we will work to get multiple offers from payment processors without your edposure to badgering sales people from multiple companies saving you time, effort, revenue, and headache. All from MaxYourPayments®

Please fill out everything you can in the application below. There are only a few pages to go through and your information will be critical to MaxYourPayments team helping you get to the next steps. Any question with an "*" is a required field.

Website

Your Website Address

Company Contact (Merchant Name)

First Name *

Last Name *

Email *

Company Contact's Email Address

Mobile Phone

Direct Phone or Company Phone

Which Phone Number is Preferred?

Would You Prefer We Call or Text?

How did you hear of us?

How did you hear of us? Name of any person(s) or organization(s) who referred you and contact info

Organization

The Businesses Corporate / Legal Name

DBA Name

Add the businesses DBA name or names, separated by commas please

Is your DBA (Doing Business As) information same as Corporate/Legal?

Legal Business Address

Address

Street Address

City

State

Country

Postal Code

Business Location Address, if Different from Legal Business Address

Business Location Street Address

If different from legal address.

Business Location Street Address 2

If different from legal address

Actual Business Location City

Business Location State

Actual Business Location Postal Code

Ownership Information (Required)

Owner's First Name

Owner's Last Name

Owner's Title

Driver's License Number

Driver's License State

Driver's License Expiration Date

MM/DD/YYYY

Owner Date of Birth

MM/DD/YYYY

Business Owner Street Address

Business Owner Street Address 2

Business Owner City

Business Owner State

Business Owner Postal Code

Business Owner Phone Number

Business Owner Mobile Number

Business Owner Email

Business Owner Percent of Ownership

A number between 1 - 100

Is this the individual You Wish to List as Management

Yes

No

Have you (your business or any principal) filed bankruptcy?

Business Bankruptcy

Personal Bankruptcy

Never

Banking Information (Required). Note: Your Information is transferred securely to MaxYourPayments.

Bank Routing Number

Bank Account Number

Does this business currently accept credit cards?

Yes

No

Monthly Volume (how many dollars / mo. via credit cards?)

$

Average Transaction Amount

$

Maximum Transaction Amount

$

Describe Your Products and Services

Customer Service Telephone Number

Any Additional Notes (Optional)

Captcha

I concent to the Terms and Conditions located here: https://www.maxyourpayments.com/terms.

I also consent to receive SMS Notifications, alerts, occasional communications, and marketing communications from the company. Message frequency varies. Message & data rates may apply. You can reply "stop" to unsubscribe from any SMS messages from our system.