Merchant Account Request Form

Collect business, sales, processing, ownership, banking, and compliance information required to review and set up a merchant payment processing account.

Finance & Fintech

Use this template

Related topics

  • Business Compliance
  • Business Verification
  • Chargeback Risk
  • E-commerce
  • KYB
  • KYC
  • Merchant Onboarding
  • Merchant Services
  • Online Payments
  • Payment Gateway
  • Payment Processing
  • Risk Assessment
  • Settlement Account
  • Transaction Volume
  • Merchant Account

Merchant Account Request Form

Business Legal Profile

Legal Business Name

The official name registered with corporate authorities.

Type your response here...
Trading Name (DBA)

If name is different from the legal name

Type your response here...
Corporate Structure
LLC
C-Corp
S-Corp
Partnership
Sole Proprietorship
Business Tax ID / EIN

The unique corporate tax registration number.

Type your response here...
Headquarters Address
Address Line 1
Not provided
Address Line 2 (Optional)
Optional
City
Not provided
State / Province
Not provided
ZIP / Postal Code
Not provided
Country
Not provided
Contact Number
Not provided
Corporate Email
username@domain.com

Digital Footprint & Sales Delivery

Website / Store URL

The live link where customers purchase products.

Type your response here...
Products / Services Sold
SaaS Software
Apparel Retail
Digital Courses
Ticketing
Delivery Timeframe
Instant / Digital Download
Shipped within 24–48 hours
Shipped within 1–2 weeks
Future Delivery / Pre-orders (Over 30 days)
Refund & Cancellation Policy URL

Mention the link showing exactly where your return policy is displayed to customers.

Type your response here...

Financial & Processing Volumes

Average Credit Card Transaction Value

e.g., $50.00

12345
Maximum Single Transaction Limit
12345
Estimated Monthly Processing Volume
$0–$10,000
$10,000–$50,000
$50,000
Does your business experience seasonal sales fluctuations?
Yes, our sales surge consistently during specific months.
No, our revenue is stable and spread evenly throughout the year.

Principal Owner / Authorized Signer Details

Full Legal Name

First, middle, and last name of the primary executive

Type your response here...
Position / Job Title
CEO
CFO
Founder
Authorized Agent
Date of Birth
Select Date
Residential Address
Full Name (Printed) *
e.g. John Doe
Expired on
Valid Till Date
Select a date
Draw Signature *
Sign within this boundary
Confirm Signature
Ownership Percentage
Type your response here...

Settlement Bank Account Details

Bank Name

The financial institution holding the business account.

Type your response here...
Account Type
Checking
Savings
Routing Number (ABA / Sort Code)

The bank's branch identification string.

Type your response here...
Account Number
Type your response here...

Terms, Risk Declarations, and Signatures

Prohibited Business Screening
I certify that the company does not operate in, or conduct business involving, any prohibited or restricted sectors, including unauthorized gambling, counterfeit goods, or other unlawful activities.
Acceptance required
Credit Check Authorization
I authorize the payment processor to conduct commercial background and business verification checks as necessary to evaluate and process this application.
Acceptance required
Electronic Signature Panel
Full Name (Printed) *
e.g. John Doe
Expired on
Valid Till Date
Select a date
Draw Signature *
Sign within this boundary
Confirm Signature

Explore this customizable form template on TovForm.

Browse more templates