Business Loan Application Form

Merchant Pre-Application

Applying for a new merchant account is fast and easy! With our Merchant Account Pre-Application, you cant start accepting credit cards within 2-3 business days. Simply complete the form submit, and your will receive a complete application for your review and signature. For further assistance you may contact us at 818.702.0024 or toll-free 800.528.1782.
Owner/Officer/Principal Name *

Prefix First Name Middle Name Last Name
Home Phone number

Area Code Phone Number
Mobile Phone number

Area Code Phone Number

Owner/Officer/Principal Home Address *

Business Information
Applying as *

Sole Proprietor S Corporation Closely Held Public Corporation LLC (Limited Liability Corporation)
Business Legal Name (If Applicable)
Business DBA (Doing Business As) *
Business Phone *

Area Code Phone Number
Business Fax

Area Code Phone Number
E-mail of Applicant *

Business Location *

Disclosure

Submit my Application
The information provided in this application shall not be shared to anyone else and is kept confidential. I acknowledge that I am the business owner or authorized officer of the business and the information is true and correct. I agree that Credit Card Industry accepts no liability for the consenquences arising out of erroneous or incomplete information supplied by me.
I agree that the information herein are true and correct

Yes
Please Run the Wizard
Equipment Communication Method
Should be Empty:

Merchant Pre-Application