No Business is Too Big, Too Small, Too New or Too Old! 98% Approval Rate! Low Fees, Fast Approval, Easy Setup! Apply NOW!

If you apply before (Midnight, ) We'll give you a FREE Merchant Account with each Fast Charge gateway set up.

By filling out this form you will not enter in to any agreements or contracts!

Please fill out this form as completely as possible. If there is any information that you do not have available or any question you do not understand, simply leave that section blank, and our staff will help you to obtain the missing information when we process your application. We're here to make sure that your application process is pleasant.

Your business must be located in the USA and you must have a physical street address. Home addresses qualify as the physical street address if home based business! Some restrictions may apply and approval is not guaranteed.

* This form is for US based businesses only. If you have a Non-U.S. based business please check out our international program here: Non US Merchants

OWNERSHIP INFORMATION Owner 1 Name Percent Owned Owner 2 Name (Leave Blank If Sole Owner) Percent Owned Contact Name Email Address Best Phone Number To Reach Legal Business Name Doing Business As (DBA) Business Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Not a US based business? Click Here for our Premier International Payment Program Business Zip Code Business Country Business Phone Number FAX Number Date The Business Opened (Month/Day/Year) About Your Business and Products Sold Product, Service or Merchandise Sold Type of Business? (Corporation,  Partnership, Sole Ownership, etc.) % Internet Orders % Mail/Phone Order % Face To Face (Swiped) Estimated Average Credit Card Sale Estimated Credit Card Monthly Volume WWW Site Address Have You Ever Accepted Credit Cards? No Yes If Yes, Do You Currently Accept Credit Cards? No Yes Which particular search  engine brought you here and what search term did  you use to find us? Example: Google.com -  searching for merchant accounts. Or Which Magazine, Post Card, Friend or Other Advertisement Etc. How Did You Hear About Us? (* Note: This has to be filled in for the form to work.) What Kind Of Equipment Or Online System Do You Want To Process Your Credit Card Orders  (Note: Banks Now Require Transactions To Be Conducted Electronically-Paper processing Is No Longer Available) Equipment Needs Online Gateway/Virtual Terminal Terminal with Built in Printer Mobile Wireless Terminal Reprogram Existing Terminal Business Owner Personal Information Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Not a US based business? Click Here for our Premier International Payment Program Zip Code Home Phone Number Rent or Own? What is your credit rating? Credit Rating Excellent Fair Poor Previous bankruptcy Feel free to tell us what you  thought about our site. If you have any additional  comments or questions please enter them here. We really appreciate the time you took and the feedback we get. We'd also like to know how you liked our site?