Merchant Application

Apply for a merchant account to start accepting payments

Step of

Business Details

Legal Business Name (as registered) *

DBA / Store Name

Ownership Type *

EIN

Date Established

Business Address *

Time at this address?

Mailing Address (if different)

Business Phone *

Website URL

NAICS / MCC (if known)

Processing Profile

Monthly Card Volume ($)

Average Ticket ($)

High Ticket ($)

% Card Present

% eCommerce

% MOTO (Mail/Telephone Order)

Primary Contact

Name *

Title

Mobile

Email *

Principal / Beneficial Owners

Describe Products/Services (including any risk factors) *

Refund Policy *

Fulfillment Time (days)

Prior Processing?

Prior Processor Name

Chargeback Ratio (last 6 mo) %

Banking Information

Depository Bank Name *

Account Type *

Routing (ABA) *

Account (DDA) *

Authorizations & Signature

ACH Authorization: I/we authorize Merchant Base and its designated PSP/MSP/acquiring bank partners to initiate ACH credits and debits to/from the account above.

Credit & Background Authorization: By signing below, each undersigned owner/officer authorizes Merchant Base and its PSP/MSP/acquiring bank partners to obtain credit reports and other background information for underwriting and review purposes.

Personal Guarantee (Optional): I agree to personally guarantee obligations arising under the merchant agreement.

Signature (Type Full Name) *

Print Name *

Title *

Email *

Date *

Upload Supporting Documents

Required Documents:

Driver's License
Articles of Organization
Void Check/Bank Letter
3 Months of Bank Statements/Last Month Processing Statement
EIN Document

Optional Documents: SSN Card, Agreement, 3 Month Processing Statements, Other

Select File

Drag & drop files here, or click to select files

Uploaded Documents:

Disclosure: Merchant Base is a Payment Service Provider / MSP partner and not a bank or a direct bank ISO. Merchant accounts are boarded with acquiring banks via our ISO/PSP partners; terms and rates are set by those providers. By submitting this application, you agree to be contacted via phone, SMS, or email regarding your application and related services.

Merchant Application

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