Step two · pre-application

Pre-application.

Everything here feeds the document checklist on the cover page and pre-populates your merchant application. Answer what you know now — it saves in this browser as you type.

Legal business

Corporate / legal nameFederal tax ID (EIN)Location addressCityStateZIPBusiness phoneBusiness emailWebsite

DBA / trade name

DBA name, address and phone are the same as legalLeave this checked if you do not operate under a different name or location.

Business & processing profile

Entity typeYears in businessContact nameProduct / service descriptionAverage ticket ($)Maximum ticket ($)Monthly volume ($)

Risk profile

Medium or high risk, or an average ticket of $500 or more, means we also need three months of bank statements.

Do you currently accept cards?

Deposit account

Bank nameRouting numberAccount number

Proof of the account you want funds deposited into

Owners of 20% or more

List every individual who owns 20% or more of the business. Each one needs a Social Security Number and a driver's license.

Owner 1

First nameLast nameTitle% ownershipSocial Security NumberDate of birthEmailPhoneHome addressCityStateZIPDriver's license numberLicense stateLicense expiration

I have a copy of this owner's driver's license ready to emailFront side, all four corners visible, unexpired.

Fee request

Request the pricing and fees you want on this account. Leave anything blank that does not apply.

Pricing model

Transaction pricing

Pass-through interchange plus (%)Visa / Mastercard / Discover rate (%)Qualified rate (%)Mid-qual surcharge (%)Non-qual surcharge (%)American Express (OptBlue) (%)Offline debit (%)

Surcharges marked with a rate are added to the qualified rate.

Offline debit: pass-through network fees

EBT & PIN debit

EBT rate (%)EBT authorization fee ($)PIN debit rate (%)PIN debit authorization fee ($)

PIN debit: pass-through network feesIf no PIN debit fees are requested, a default rate of 0.85% + $0.35 per transaction applies.

Other fees

Authorization fee ($)Batch fee ($)Transaction fee ($)Chargeback fee ($)Retrieval fee ($)Monthly dashboard access fee ($)Voice authorization / IVR fee ($)AVS transaction fee ($)Monthly minimum fee ($)Monthly fee ($)Application fee ($)Annual fee ($)Monthly PCI fee ($)Other fee typeOther fee amount ($)Other fee billing method

POS hardware

Hardware purchase amount ($)Terminal type

Equipment billable to

Non-billable program

Service provider fees

Gateway fee ($)Wireless fee ($)POS system fee ($)Per transaction fee ($)Setup fee ($)Monthly service fee ($)Other service fee ($)Other service providersSpecial pricing or exception notes

Disclaimer

Fees requested in this section are subject to approval from the processor. Final fees will be those shown on the executable merchant application.

Documents you'll attach

3 most recent processing statementsAll pages, including the summary page showing the merchant name.

Bank statements aren't required for a low-risk profile with an average ticket under $500.

When you're done

Download every completed form, then email them along with the checklist documents to support@paydivy.com. Nothing is sent from this page for you.

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