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Merchant Application Worksheet

Once you have received a  proposal from Credit Card Processing Services and have decided to use our services, please fully complete this worksheet.   What we will do with the information which you provide is to transfer it to the original application for the respective bank which we have mutually decided is best for your specific company and needs.  We will then forward the application direct to you as all banks require original signatures on original paperwork.  We will also include a checklist noting each of the items which we will need to process your application.   As soon as we receive back the original application package from you we will immediately begin processing your application.  Depending upon the bank you can realistically expect to receive a decision in about a week (give or take a few days).   When your merchant ID goes "live" on the processor's computers (usually the next day) at that time we can download your terminal or ship your software.

Please Note - If you have not yet received a proposal from us then please go back to our home page and click on the "I Want More Info" button and complete the short Merchant Information Profile.  I will then call or e-mail you to discuss your specific needs in detail.  Thank you.

Business Information:
Business DBA Name
Legal Name
Address Line 1
Address Line 2
State Zip Code

Business Phone Number (Please Include Area Code)
Home Phone Number (Please Include Area Code)
Fax Number (Please Include Area Code)

Your e-mail address

Federal Tax ID Number (EIN)

Date Business Started (MM/YY)

Which legal category describes your business:

Owner's Information:
Owner's Full Name
Title (Ex - Owner, Partner, President)
Home Address
State Zip Code

Percentage of Ownership

Social Security Number

Date of Birth (MMDDYY)

If more than one owner please provide the same above information to CCPS for each owner.  Please enter any additional owner information in the Comment section below.

Trade References (Please Provide Three):
Business Reference #1
Contact Name or Account Number
Reference Phone Number (Include Area Code)

Business Reference #2
Contact Name or Account Number
Reference Phone Number (Include Area Code)

Business Reference #3
Contact Name or Account Number
Reference Phone Number (Include Area Code)

Landlord (If Renting or Leasing)::
Landlord Company Name
Landlord Contact Name
Landlord Phone Number (Include Area Code)

Bank Reference:
Name of Bank
Bank Address
State Zip Code

Bank Contact Name (If Applicable)
Bank Phone Number (Include Area Code)

Routing Number (ABA) - 9 Digits Found on Bottom Left of Check
Checking Account Number

It will be necessary to provide either a preprinted voided business check or a letter from the bank stating your business has a business checking account noting the ABA and DDA numbers.  It should be typed on bank letterhead and signed by a bank employee.  Fax to 215-489-7880.

Questions or Comments:

All information is held in the strictest confidence.  Thank you.

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