Please enable JavaScript in your browser to complete this form.BUSINESS INFORMATIONBasic information on the business and the merchant/OwnerMerchant’s DBA Name/Outlet Name: *Merchant’s Legal Name: *DBA Physical Street Address (No P.O. Box): *Legal Address: (if different from Business Address) *City, Province, Postal Code: *City, Province, Postal Code: *DBA Phone: *Corp. Phone: *Contact Name at this Address: *Email: *Contact Name at this Address: *Email: *Customer Service Phone #Required for MOTO and Internet merchants only.Website Address: *Required for Internet merchants.DEPOSIT ACCOUNT INFORMATIONThis lets us know where to send your money once payments are settled.Merchant Number: *Merchant Bank Account Transit and Account Number: *FID *TRANSIT *ACCOUNT *MERCHANT INFORMATIONInformation o the legal aspects of the business.GST/HST Number *Type of Ownership *PartnershipNon-ProfitSole ProprietorLimited (LTD)CorporationGovernmentOtherPAYMENT CARD INFORMATIONWhat type of business do you run? Multiple selections are OK here.Checkboxes *RetailRestaurantLodgingMO/TOE-commerceSupermarketEmerging MarketAuto RentalOil & GasOtherSALES PROFILEWhat percentage of your current sales come from each of the three options below. Sales profile must equal 100%Electronic Chip and PIN *Internet Sales *Card-Not-Present / Manually Keyed *CARD ACCEPTANCE PROFILEWhat cards you sue currently (if any), what you sell, and how you sell it. Some selections you make here will reveal additional fields if we need more information from you.Do you currently accept:VISA? *YESNOMASTERCARD? *YESNOAMERICAN EXPRESS? *YESNODISCOVERY? *YESNOFUTURE DELIVERY OF PRODUCTSDo you process future delivery of products and/or services? *YESNODo you take payments from customers but not deliver the product right away?Deposit on future delivery% of sales / Day(s) in advance takenCustom work sold on terms of future delivery: *YESNO% of sales / Day(s) delay on delivery:% 0-5 days:%, 6-14 days *%, 15-30 days%, >30 days%,Days of future delivery greater than 30?Do you maintain the inventory of products? *YESNOTICKET PRICEWhat is the average price people pay across all the products on your store?AVERAGE *HIGH *RETURN PROCESSINGDo you wish to process returns? If so how much for each? Fields will appear if needed based on your selections.CREDIT RETURNS? *YESNOAMOUNT?DEBIT RETURNS? *YESNOAMOUNT?SALES VOLUMEIf you are not currently processing cards, just put these in at zero (0)Annual Credit Card Sales Volume: *Annual Debit Card Sales Volume: *Annual Interac Debit Card Sales Volume: *OWNER/OFFICER INFORMATIONPlease complete for every person who ultimately owns or controls the operation or on whose behalf the transactions authorized under this agreement will be conducted.Name *FirstLastPhone *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDate of BirthOwn or Rent *OwnRentYears at LocationLived There Less Than A Year? *YESNOIf you have lived at your current location for less than a year please enter your previous address.AddressAddress Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountrySUPPORTING DOCUMENTATIONTo get started we need copies/scans/images of the following documentation so we can pre-fill the form for you and get it ready for you to look over and sign. If you are a first time applicant you may not have all these documents (usually the bank and card processing statements). Thats OK! If you do NOT have any of the following, DON’T PANIC! Just disregard and upload what you have. Please reach out to your customer service rep and we can verify if you need it, or how we can work around it. These can all be sent in zipped format if the scans and PDFs get too big. – Business registration/license/Articles of Incorporation – Driver license of the principal – 3 to 6 months of credit card processing statements (if applicable) – 3 to 6 months Bank processing statements (if applicable) File Upload Click or drag files to this area to upload. You can upload up to 8 files. CommentSubmit