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Fill out our pre-qualification form

How Did You Hear About Us?

Other:

Your Name

Your Email

Your Phone


Company Name

DBA / Trading Name (optional)

Company Street Address

Company City, State, Postal, Country

Country of Incorporation


Description of products or services

Web Site URL(s)

Test Username

Test Password

Customer Support Number

Customer Support Email

Method of Acceptance (must equal 100%)
% Web/online sales % MOTO/call center % Swipe/POS

Target Markets (must equal 100%)
% USA % Europe % Asia % Latin America % Other


This business needs credit card processing.

This business is currently accepting credit cards.

How long have you been accepting credit cards?

Current Payment Service Provider(s)

Reason for Change

I can provide 3 months processing statements:

Monthly Credit Card Volume
Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.

Average Credit Card Transaction Value

Highest Credit Card Transaction Value


This business needs eCheck processing.

This business is currently accepting eChecks.

How long have you been accepting eChecks?

Current Payment Service Provider(s)

Reason for Change

I can provide 3 months processing statements:

Monthly eCheck Volume (in USD)
If you are a startup please use projected figures.

Average eCheck Transaction Value

Highest eCheck Transaction Value


This business needs SEPA direct debit processing.

This business is currently accepting SEPA direct debit.

How long have you been accepting SEPA direct debit?

Current Payment Service Provider(s)

Reason for Change

I can provide 3 months processing statements:

Monthly SEPA Direct Debit Volume (in EUR)
If you are a startup please use projected figures.

Average SEPA Direct Debit Transaction Value

Highest SEPA Direct Debit Transaction Value

This business needs China UnionPay processing.

This business is currently accepting China UnionPay.

How long have you been accepting China UnionPay?

Current Payment Service Provider(s)

Reason for Change

I can provide 3 months processing statements:

Monthly China UnionPay Volume
Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.

Average China UnionPay Transaction Value

Highest China UnionPay Transaction Value

This business needs Latin America processing.

Monthly Latin American Volume
Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.

Average Latin American Transaction Value

Highest Latin American Transaction Value

This business needs local bank transfer processing.

Monthly Local Bank Transfer Volume
Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.

Average Local Bank Transfer Transaction Value

Highest Local Bank Transfer Transaction Value

This business needs crypto currency processing.

Monthly Crypto Currency Volume
Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.

Average Crypto Currency Transaction Value

Highest Crypto Currency Transaction Value


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