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PSP Setup
Pre - Application
Business Information
Legal Business Name:
*
DBA (Doing Buisness As):
*
Legal Address:
*
Legal City / State Address:
*
Legal Postal Code
*
Legal Country Address:
*
Mailing Address:
*
Mailing City Address:
*
Mailing Country Address:
*
Business Start Date
*
State of Incorporation:
*
Business Established In What Year:
*
Square Footage of Premises:
*
Location:
*
Zoning Area:
*
MC Code (if applicable):
Length of Ownership: ___Years ____ Months:
*
Length at Current Location: ___Years ____ Months:
Website URL:
*
Business Email:
*
Business Phone:
*
Fax Number:
*
Contact Name (First & Last Name):
*
Ownership Type:
*
Descriptor (22-character limit):
*
Type of Goods Sold:
*
Does Inventory / Staff match Business Type?:
*
Yes
No
Ownership / Officer Information
First name
*
Last name
*
Title:
*
Ownership %:
*
Home Adress:
*
Home City / State Address:
*
Home Postal Code:
*
Email
*
Mobile Phone:
*
Home Phone:
Date of Birth
*
Social Security Number:
*
Driver's Licensee Number:
*
License Expiration Date:
*
License State:
*
Time at Current Residence: ___Years ___ Months
*
Resident Status
*
Own
Rent
Authorized Signer?
*
Yes
No
Landlord Name:
*
Landlord Phone:
*
Banking Information
Bank Name:
*
Bank Contact Name:
*
Bank Phone:
*
Account Number:
*
Routing Number:
*
Card Processing Details
Previously Terminated as a Merchant?
*
Yes
No
Accept VISA / MC / DISC / AMEX?
*
Yes
No
Submit 3 Most Recent Monthly Statements
*
Upload File
Processor Name:
*
Username
*
Password
*
Third-Party / Payment Application Involved?
*
Yes
No
If Yes, Identify:
PCI Compliant?
*
Yes
No
Data Compromise History?
*
Yes
No
Identified in Visa Risk Programs?
*
Yes
No
Transaction Profile & Volume
Transaction Profile
*
Accepted Card Brands:
*
Max Monthly Volume:
*
Average Ticket $:
*
Highest Ticket $:
*
Estimated Yearly Volume $:
*
Transaction Type (must total 100%): Swiped ___%, Keyed ___%, Online ___%
*
Business Premises
Premises Type:
*
Lease
Own
Landlord Name:
*
Landlord Phone:
*
Accept American Express?
*
Yes
No
Accept American Express Marketing?
*
Yes
No
Declarations
Premises Inspection Completed?
*
Yes
No
Additional Notes
Submit
3597 E Monarch Sky Ln
Meridian, ID 83646
+1(480) 465-6868
info@compaytence.com
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