SmartPay Merchant Service

Merchant Account Request

Thank you for considering SmartPay Merchant Service for your merchant services needs! To ensure we can provide the best solution for your business, we kindly ask you to complete the following questionnaire. Your responses will help us understand your business better and tailor our services to meet your specific requirements.

Please take a few moments to fill out the form, and don’t hesitate to reach out if you have any questions along the way. The information you provide is confidential and will be used solely to process your merchant account request. We look forward to helping your business grow and succeed!

Best regards,
SmartPay Merchant Service

Merchant Account Request Questionnaire

Business Information

Business Name: *

DBA (Doing Business As) Name (if applicable):

Business Address: *

City, State, Zip Code: *

Business Phone Number: *

Business Email Address: *

Business Website (if applicable):

Contact Information

Owner/Contact Name: *

Contact Phone Number: *

Contact Email Address: *

Title/Position in the Company:

Business Details

Business Type (Industry): *

Describe your products or services: *

How long have you been in business?: *

Estimated monthly sales volume: *

Average transaction amount: *

Highest expected transaction amount: *

How do you sell your products/services? (check all that apply): *

In-store

Online

By phone/mail order

Other

Payment Processing Needs

What types of payments would you like to accept? (check all that apply): *

Credit Cards

Debit Cards

ACH/Direct Debit

Other

Are you currently processing payments? *

Yes

If yes, who is your current payment processor?:

What is your current processing rate (if applicable)?:

Do you use any specific POS (Point of Sale) systems? *

Yes

If yes, please specify the system name:

Risk and Compliance

Do you process any high-ticket or high-risk transactions (e.g., over $5,000)? *

Yes

Are there any chargeback or refund concerns? *

Yes

Have you ever had a merchant account terminated or rejected? *

Yes

If yes, please provide details:

Additional Information

What are your expectations from the new merchant services provider? *

Is there any other relevant information we should know to serve your needs better?

Preferred Communication Method

How would you like to be contacted for further questions or updates? *

Phone

Text

Other