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.