high risk merchant account application

Merchant Application

Please fill out ActiveMerchant Corporation Pre-Application. Specialist will contact you within 1 business day.

Click here - Understanding Entire Procedure of Setting up a New Client!

Legal Name of Business / DBA:
URLs
Contact Name/ First, Last Name:
Contact Email Address:
Contact Phone:
Contact Fax:
Country of Incorporation:
Product being sold:	(please describe in details!)
Average Ticket Cost:
Projected Monthly Volume:
Recurring Billing:
Are you Currently Processing:
If Yes, with who:
Ever been Terminated?
If Yes, why:

Special Requirements or Notes:

By submitting this application you are agreeing that all the information you have provided above is accurate and correct to the best of your knowledge. You are also authorizing Active Merchant Financial Corporation. To perform background checks for any commercial or personal criminal activity.