Merchant Application - Painless Processing

SSL Secure Application

If you have any questions about the application, please call us at 877-996-2795. Likewise, you can have a merchant services agent complete the application for you over the phone. Please note, leaving this page could result in you having to restart the online application process.

Step 1 of 5 - Basic Information

Contact Information & Type of Business
Legal Business Name:*

Enter the full legal name of the company as filed on the articles of organization
Doing Business As:*

Enter the Name of the company as you want it to appear on customer receipts and statements. This should mirror you DBA filing with the state.
Contact Name*
First Last
The first and last name of the primary contact with regards to this application.
Contact Phone*
Direct phone number to the contact name. This is what we will use to contact you.
Contact Email:*

Direct email to the contact name. This is what we will use to contact you.
Business Industry*
Pick the industry the best fits the product or service you sell. If you don’t see your industry or are unsure, choose OTHER.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Sub-Industry:*
Briefly Describe Your Business:*

Tell us what products or services you sell.
Briefly Describe Your Business:*

Tell us what products or services you sell.

Business Information
Mailing Address:*

Enter the address where you want all business correspondence mailed.
City:*
State:*
ZIP CODE:*
Website Address:*

Enter the website for the business. If there is no website, enter NONE.
EIN #*

The Employer Identification Number (EIN), also known as the Federal Employer Identification Number or the Federal Tax Identification Number.
Is your mailing address the same as the location of the business?*
- YES
- NO
Street Address:*

Enter the address where the business in located.
City:*
State:*
ZIP CODE:*
Business Location Phone:*
Customer Service Phone:*

Enter the phone number you want on your receipts. This should be the number customers are given for customer service.
Number of Locations:*
Date Business Started:*
Type of Entity:*
Entity State:*
Enter the state your business was incorporated in.
Do you have a D&B Number?*
Dun & Bradstreet (D&B) record w/ information on commercial credit as well as reports on businesses.
D&B #*

Owner Information
Owner's Name*
First Name M.I. Last Name
Residential Address:*
City:*
State:*
ZIP CODE:*
Phone:*
Email:*
Social Security #:*
Length of Current Ownership:*
Years of Experience in Industry:*
Have you ever been placed on the TMF list (Terminated Merchant File)?*
Will there be a second owner on this application?*
Second Owner's Name*
First Name M.I. Last Name
Residential Address:*
City:*
State:*
ZIP CODE:*
Phone:*
Email:*
Social Security #:*
Length of Current Ownership:*
Years of Experience in Industry:*
Have you ever been placed on the TMF list (Terminated Merchant File)?*
Bank Information
Bank Name:*

Enter the Bank, Routing #, and Account # you want processing deposits to go to and fee withdrawals to come from.
Routing #*
Account #*
Do you already have, or have you had, a merchant account in the last 90 days that deposits to or withdraws from this bank account?*

Supporting Documents
Supporting documents ARE NOT REQUIRED at this time. To submit your application WITHOUT documentation, SCROLL to the BOTTOM of the page and CLICK SUBMIT.

All merchant account applications require supporting documentation. Certain industries, business models, and/or applicants require more and/or specific documents and information. Your dedicated merchant services agent and our underwriting team will inform you of any additional required documents or information and explain why they are needed. You can submit any or all documentation directly to them. If you have any questions, please contact us.
Owner ID / Drivers License
Accepted file types: doc, docx, odt, pdf, rtf, tex, txt, wks, wps, wpd, jpg, jpeg, png, gif, tif, xlm, xlsx, xlsm, csv, Max. file size: 64 MB.
Voided Check or Bank Verification Letter
Drop files here or

Accepted file types: doc, docx, odt, pdf, rtf, tex, txt, wks, wps, wpd, jpg, jpeg, png, gif, tif, xlm, xlsx, xlsm, csv, Max. file size: 64 MB, Max. files: 1.
Last Three (3) Months Bank Statements
Drop files here or

Accepted file types: doc, docx, odt, pdf, rtf, tex, txt, wks, wps, wpd, jpg, jpeg, png, gif, tif, xlm, xlsx, xlsm, csv, Max. file size: 64 MB, Max. files: 3.
Last Three (3) Months Merchant Account Statements (If Applicable)
Drop files here or

Accepted file types: doc, docx, odt, pdf, rtf, tex, txt, wks, wps, wpd, jpg, jpeg, png, gif, tif, xlm, xlsx, xlsm, csv, Max. file size: 64 MB, Max. files: 3.
Email
This field is for validation purposes and should be left unchanged.

SSL Secure Application

Step 1 of 5 - Basic Information

Contact Information & Type of Business

Business Information

How does your business operate?

Owner Information

Bank Information

Supporting Documents

ABOUT

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HIGH RISK INDUSTRIES

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MERCHANT APPLICATION FORM

SSL Secure Application

Step 1 of 5 - Basic Information

Contact Information & Type of Business

Business Information

How does your business operate?

Owner Information

Bank Information

Supporting Documents