Merchant Hero

sean@merchantheroz.com

844-PAY-ZERO

Section 1 of 8 in this document

Tell Us What Solution You're Interested In

What Solution Would You Like?

Which Model?

Which Plan Are You Interested In?

Option 1: Purchase

Option 2: Payment Plan

Option 3: Lease

Option 4: Merchant Owned

Quantity:

Please Specify Product:

Section 2 of 8 in this document

Tell Us A Little About Yourself

Full Name:

Email Address:

Phone Number:

Section 3 of 8 in this document

Tell Us About Your Business

Legal Business Name:

Doing Business As (DBA):

Type of Ownership:

Date Business Started:

Number of Locations:

Product / Service Sold:

Federal Tax ID Number:

Website:

Bank Name:

Bank Account # (DDA):

Bank Routing # (ABA):

Section 4 of 8 in this document

Tell Us More About Your Business

Is Your Physical Location Address The SAME As Your Corporate Address?

Yes

Indicate if Classified as:

Small Business

Disadvantaged Business

None

Section 5 of 8 in this document

Tell Us About Your Sales

Do you currently accept Visa/MC/Discover® Network?

Yes

Estimated Average Ticket Amount

Estimated High-End Ticket Amount

Estimated Monthly Card Volume ($)

Estimated Monthly Amex Volume

How Do You Plan On Accepting Payments? (Use Percentages)

% Store Front/ In-Person

% Phone Order (Keyed)

% Internet Services

Section 6 of 8 in this document

Tell Us More About Your Sales

What is your return, cancellation, or refund policy?

What % of sales are with international cards?

Who owns product?

Merchant

Vendor (Drop Ship Required)

Are consumers required to provide a deposit?

Yes

What is the Deposit Percentage:

Section 7 of 8 in this document

Tell Us About Your Ownership

Name

Title

Date of Birth

Social Security Number

Ownership %

Are there any other Owners that own 25% or more?

Yes

Name

Ownership %

Date of Birth

Social Security Number

Upload Driver's License and Voided Check

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Additional Questions/Comments?