Merchant Application Form

For more information, or assistance with a credit card processing merchant account from High Risk Credit Card Processor, please fill out the inquiry form provided below and a High Risk Credit Card Processor representative will contact you within 24 hours.

Email Contact:
amslv@cox.net

High Risk Credit Card Processor
702-456-1116

High Risk Credit Card Processors Specializing in High Volume Merchant Accounts

Fields marked with a * are required.

    PRODUCTS / SERVICES

    How were you referred to High Risk Credit Card Processor:


     Other

    Products/Services you are seeking:

     

     

     

    Credit Card TerminalInternet GatewayUS Based Merchant Account3rd Party ProcessingACH ProcessingATM MachinesCheck Processing TerminalInternet Virtual TerminalOffshore Merchant AccountCheck GuaranteeCheck Conversion

    BUSINESS INFORMATION

    Business Name:

    *

    Contact Name/Title:

      E-mail:

    *

    Phone:

    *

    Cell Phone:

    Business Address:

    City:

    State:

    Zip:

    Country:

    Phone:

      Fax:

    Website:

    ABOUT YOUR BUSINESS

    Are you a startup:

    YesNo

    Age of business:

    Products/Services Sold:

    How is your product/service sold:

     

    Retail Storefront:


    %

     

    Mail Order:


    %

     

    Inbound Phone Sales:


    %

     

    Outbound Telemarketing:


    %

     

    Internet:


    %

    		 

    Total:

    100%

    		  


    Current Monthly
    Volume: $

     

     

     

    Projected Monthly Volume: $

     

     

     

    Average Credit Card Transaction: $

     

     

     

    Highest Credit Card Transaction: $

     

     

     


    Have you ever been terminated

    by
    a processor before?

    If YES, please explain in

    comments box below.

    YesNo

    If so, by what banks/processors?

    Who do you currently process with?

    What banks/processors have you processed with in the past?

    Why are you not with them anymore?

    Who have you applied with so far?

    How is the signers personal credit?

    Credit Score:

    Comments:

     

     

    Contact Us

    Please take about 1 minute to complete our NO OBLIGATION quick form and submit it to us. This will allow our team to evaluate your needs and present a banking / pricing solution for your particular business.

     

    High Risk Credit Card Processors
    Phone: 702-456-1116
    amslv@cox.net
    https://highriskcreditcardprocessor.com

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