High Risk Application We offer solutions for any business challenge. Step 1 of 6 16% Legal Name of Business*DBA (Doing Business As)*Owner First Name*Owner Last Name*Email* Phone*Time Zone*(GMT -12:00) Eniwetok, Kwajalein(GMT -11:00) Midway Island, Samoa(GMT -10:00) Hawaii(GMT -9:00) Alaska(GMT -8:00) Pacific Time (US & Canada)(GMT -7:00) Mountain Time (US & Canada)(GMT -6:00) Central Time (US & Canada), Mexico City(GMT -5:00) Eastern Time (US & Canada), Bogota, Lima(GMT -4:00) Atlantic Time (Canada), Caracas, La Paz(GMT -3:30) Newfoundland(GMT -3:00) Brazil, Buenos Aires, Georgetown(GMT -2:00) Mid-Atlantic(GMT -1:00 hour) Azores, Cape Verde Islands(GMT) Western Europe Time, London, Lisbon, Casablanca(GMT +1:00 hour) Brussels, Copenhagen, Madrid, Paris(GMT +2:00) Kaliningrad, South Africa(GMT +3:00) Baghdad, Riyadh, Moscow, St. Petersburg(GMT +3:30) Tehran(GMT +4:00) Abu Dhabi, Muscat, Baku, Tbilisi(GMT +4:30) Kabul(GMT +5:00) Ekaterinburg, Islamabad, Karachi, Tashkent(GMT +5:30) Bombay, Calcutta, Madras, New Delhi(GMT +5:45) Kathmandu(GMT +6:00) Almaty, Dhaka, Colombo(GMT +7:00) Bangkok, Hanoi, Jakarta(GMT +8:00) Beijing, Perth, Singapore, Hong Kong(GMT +9:00) Tokyo, Seoul, Osaka, Sapporo, Yakutsk(GMT +9:30) Adelaide, Darwin(GMT +10:00) Eastern Australia, Guam, Vladivostok(GMT +11:00) Magadan, Solomon Islands, New Caledonia(GMT +12:00) Auckland, Wellington, Fiji, Kamchatka Website Do you sell your product or service using a free trial offer?*YesNoBusiness Phone*Federal Tax ID*Years of OwnershipMonths of Ownership*Types of goods/Services you sell*Business Type*Sole PropreitorPartnershipCorporationLLCBusiness Zoning*CommercialResidentialIndustrialBusiness Start Date* Business Address* Street Address City ZIP / Postal Code State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCountry*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Owner Name* First Last Driver's License or ID*Social Security Number or National ID Number*Ownership %*Owner Address Street Address City ZIP / Postal Code State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCountry*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweDo you rent or own?*RentOwnYears at Residence Location*Months at Residence Location*Please enter a value less than or equal to 11. Estimated Monthly Card Sales*Average Single Sale Amount*Maximum Single Sale Amount*Business Transaction TypeRetailMail/Phone OrdersInternet On Premise Sales %*Please enter a value between 0 and 100.Internet Order %*Please enter a value between 0 and 100.Mail Order %*Please enter a value between 0 and 100.Telephone Order %*Please enter a value between 0 and 100.Off-Premises Sales %*Please enter a value between 0 and 100.Sales Swiped %*Please enter a value between 0 and 100.Sales Keyed %*Please enter a value between 0 and 100.Bank/Financial Institute Name*Routing #*Account #*Have you ever had a merchant account terminated?*YesNoTMF/MATCHWould you like to accept American Express*YesNoHas any principle filed bankruptcy?*YesNoDo you currently accept Visa/MasterCard/Discover?*YesNo 1. Pre-printed voided check or a signed bank letter dated in the last 30 days with the routing and account numbers. Cannot be a starter check. DBA or legal name must be printed on check.*Accepted file types: jpg, png, pdf.2. Three months previous processing statements (if applicable). Cannot be a printout of the transaction summary.Accepted file types: jpg, png, pdf.3. Three months business checking account statements. Cannot be a printout of the transaction summary.*Substitute personal checking statements if there are no business checking statements.Accepted file types: jpg, png, pdf.4. Marketing material: website, brochures and business card.Accepted file types: jpg, png, pdf.5. Copy of your driver’s license. Must match principal's name on pre-application.*Accepted file types: jpg, png, pdf.6. Phone script used for incoming customer/client calls.Accepted file types: jpg, png, pdf.7. EIN or SS4 Document*Accepted file types: jpg, png, pdf.8. Articles/LLC documentation/business license (if applicable)*Accepted file types: jpg, png, pdf.9. Price list for products/services.Accepted file types: jpg, png, pdf.10. ecommerce ONLY: Complete description of goods and services, customer service contact information including email address and phone number, delivery policy must be clearly stated, price for product or service, privacy policy specifying use of customer data, information on when the card is charged, active shopping cart, secure method for the transmission of payment data (SSL Secured 128 bit).*Accepted file types: jpg, png, pdf. This iframe contains the logic required to handle Ajax powered Gravity Forms.