COMPANY INFORMATION Required field!
Company Legal* Required field!
Company DBA Required field!
Company Main URL* Required field!
Company Address* Required field!
City* Required field!
State* Required field!
Zip* Required field!
Type of Business* Required field!
Primary Contact* Required field!
Primary E-mail* Required field!
Type of Ownership* Required field!
Ticker Symbol (if publicly traded) Required field!
PAYMENT PROCESSING INFORMATION Required field!
Sales Profile* Required field!
Description of Services or Goods Sold* Required field!
Average Transaction Value* Required field!
Monthly Gross Processing Volume* Required field!
Card Authorization Currencies (list all that apply)* Required field!
Card Settlement Currencies* Required field!
Are transactions recurring?* Required field!
Are transactions processed in a MOTO environment?* Required field!
Average time between date of charge and delivery* Required field!
Production URLs (list all that apply)* Required field!
Terms and Conditions URL* Required field!
Cancellation/Refund Policy URL* Required field!
SYSTEMS Required field!
Current Payment Platforms (list all)* Required field!
Current Gateway (Connectivity)* Required field!
Can you change Gateway(s) if required for new solution?* Required field!
Current e-commerce platform (list all)* Required field!
Fraud and Chargeback vendors (list all)* Required field!
Other payment related third parties (list all)* Required field!
OTHER Required field!
Are Dynamic/Soft Descriptors Required?* Typically used for company that have multiple DBAs being processed through same system. Required field!
Is Account Updater Required?* Used to verify card and expiration date information by recurring/subscription merchants. Required field!
Are you PCI compliant?* Required field!
Are you currently a registered PayFac or TPP?* Required field!
Other than cards, what other payment products do you accept?* Required field!
Anything else you would like us to know? Required field!
Section Required field!
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