Merchant Application

Thank you for your interest in RevitMerchants. Please fill out the form to the best of your knowledge to process your application.

Referral Agent's DBA Name

Sales Representative *

Legal Business Information

Legal Entity Name

Legal Entity Address

Legal Entity City

Legal Entity State

Legal Entity Zip Code

Legal Entity Country

Type of Ownership

State of Formation

Federal Tax ID Type

FEIN or Social Security Number

Date Business Was Established

Number of Years Business Owned

Any Prior Bankruptcy?
Yes No

Does Business As (DBA) Information

Is the DBA information the same as Legal?
Yes

DBA Name

DBA Address

DBA City

DBA State

DBA Zip Code

Business Location Information

Type of Zoning for your business

Square Footage of the Location

Number of Locations

Number of Employees

Business Contact Information

Primary Contact Full Name

Business Contact Email

Business Contact Phone Number

Customer Service Email

Customer Service Phone Number

Do you have a website?

Yes No

Technical Contact Information

Technical Contact Full Name

Technical Contact Email

Funds Settlement Bank Information

Bank Name

ABA Routing Number

Bank Account/DDA Number

Goods & Services

Type of Industry

If not listed above, please type industry here

Type of Goods/Services Provided

Describe the Goods/Services Provided

Percentage Provided by Card Present Swiped

Percentage Provided by Card Present Not Swiped

Percentage provided by card present swiped + Percentage provided by card present not swiped must equal 100%.

Percentage Provided by Internet

Percentage Provided by Mail Order

Percentage provided by internet + Percentage provided by Mail order + percentage provided by phone must equal 100%.

Percentage of Sales to Consumers

Percentage of Sales to Businesses

Percentage of sales to consumer + percentage of sales to businesses + percentage of sales to government must equal 100%.

Goods/Services Delivery Period

Refund Policy

Is a deposit required on any sales?
Yes No

Product Fulfillment

Do you use product fulfillment services?
Yes No

Do you use a shopping cart?
Yes No

Processing Summary & History

Annual Processing Volume

Visa & MC + Amex + Discover.

Visa & MasterCard Annual Volume

AMEX Annual Processing Volume

Discover Annual Volume

Max Monthly Processing Volume

Max Ticket Size

Number of Max tickets per year

Average Ticket Size

Have you ever had a merchant account terminated?
Yes No

Do you accept bank cards now?
Yes No

Who is your current processor?

Current Gateway Vendor Name

Principal #1 Personal Information

Principal First Name

Principal Last Name

Principal Title

Principal Percentage of Ownership

Principal Home Address

Principal City

Principal State

Principal Zipcode

Does the Principal Rent or Own a home?
Rent Own

Years Principal Lived at Current Home

Principal Home Phone

Cannot be same as Customer Service nor Business Phone

Principal Email

Cannot be same as Customer Service nor Business Email

Government Issued ID Type

Government Issued ID Number

Government Issued ID State

Government Issued ID Issue Date

Government Issued ID Expiration

Principal Social Security Number

Principal Date of Birth

Principal #2 Personal Information

Is there a Principal #2?
Yes No

Principal First Name

Principal Last Name

Principal Title

Principal Percentage of Ownership

Principal Home Address

Principal City

Principal State

Principal Zipcode

Does the Principal Rent or Own a home?
Rent Own

Years Principal Lived at Current Home

Principal Home Phone

Cannot be same as Customer Service nor Business Phone

Principal Email

Cannot be same as Customer Service nor Business Email

Government Issued ID Type

Government Issued ID Number

Government Issued ID State

Government Issued ID Issue Date

Government Issued ID Expiration

Principal Social Security Number

Principal Date of Birth

Upload Supporting Documents (PDF Format Only)

Driver's License (Must be active)

Articles of Incorporation

Social Security Number or FEIN document

Voided Check or Bank Letter - must match the bank name on the MPA

Business Bank Statements - Last 3 months

Home or business utility bill

Fulfillment Agreement (Only if using a fulfillment house)

Customer Service Contract (Only if outsourcing)

Processing Statements - Last 3 months (Only if you are processing)

Final Step

Please ensure the information provided is correct, once you're ready to submit, please click the submit button below.

I have reviewed the fields and filled out the forms truthfully.

Submit Merchant Form