mycropay logo Innovative solutions you can depend on!
Open an Account
General Business Information
Business Legal Name
Business Name/Doing Business As Name ( 25 characters )
Location Address
City
 State Zip Country
Phone
 Fax
Email
 URL (Web Site) Address
Contact Name
 Contact Phone
Contact Fax
 Contact Email
Mailing Address if Different from Location Address
City
 State Zip Country
Ownership Type
Partnership Public Corp
State Incorporated
 Month / Year Started
Number of Employees
 Corporate Identification Number (9 digits)
Ownership Information
First Owner, Partner, Officer Name
 Title Social Security Number
Date of Birth Drivers License # State
Equity Ownership %
Home Phone
Home Address
City
 State Zip Country
Second Owner, Partner, Officer Name (If Applicable)
 Title Social Security Number
Date of Birth
 Drivers License # State
Equity Ownership %
Home Phone
Home Address
City State Zip Country
References
Current Bank Name
 Account Number
Contact Name Contact Phone
Trade Reference 1 Name
 Contact Phone Account Number
Trade Reference 2 Name
 Contact Phone Account Number
Trade Reference 3 Name
 Contact Phone Account Number
Are Your Business Premises


If rented/leased, please fill out the following:

Occupied Since (mmyy)
 Lease Expires (mmyy)
Landlord Name
 Contact Name Contact Phone
Address
City
 State Zip Country
Specific Business Information
Total Sales

$ Expected Mo. Sales $ Expected Mo. CC Sales $

Expected Mo. Check Sales $ Average Ticket Amount $ Estimated ACH Processing Volume
Monthly Credits #   $
Monthly Debits #   $
Monthly Returns #   $
Business Type
(check all that apply) :		 Retail Card Swipe  Mail / Telephone Order  Internet  Signature on File 
Other
Method of Sale: Card Present Swipe % + Keyed % + Internet % + Signature on File % = 100%
Type of Sale: Business to Business % + Business to Consumer % + Whole Sale / Distributor % = 100%  
Method of Advertising: Catalog Direct Mail   TV / Radio  Internet Email Phone Print
Other
Time Frame from Transaction to Delivery Delivered Immediately: % + 1-3 days % + 4-7 days % + 8-15 days % + over 30 days % = 100%
Method of Delivery of Service(s) or Product(s): Merchant Manufacturer Distributor Other
Customer Service Phone
Return & Refund Policy:
Describe in Detail What Type of Business You are in, Product(s) Sold or Service(s) Provided & Method of Sale:
Depository Account Information
Merchant hereby authorizes TRANSYSA, in accordance with this Agreement, to initiate debit/credit entries to Merchant's depository account, as indicated below. This authority is to remain in full force and effect until (a) TRANSYSA has received written notification from Merchant of its termination, in such a manner as to afford TRANSYSA reasonable opportunity to act on it and (b) all obligations of Merchant to TRANSYSA. that have arisen under this Agreement have been paid in full.  Return item fee is $25 per incident for any reason. 
Bank Name
 Account Number
Transit Number (9 digits) Account Type
Contact Name Contact Phone
Address
City State Zip Country

All information contained in this application has been completed or supplied by all contracting parties. Merchant accepts all contractual aspects of the Agreement. Merchant understands that this Agreement shall not take effect until accepted and signed by TRANSYSA.  By accepting these terms, I certify all information is true and correct and that by accepting these terms and conditions, unconditionally guarantee to TRANSYSA and its successors and assigns the full and prompt payment when due of all of the obligations of every kind and nature of MERCHANT arising directly or indirectly out of the Agreement. I hereby authorize TRANSYSA to obtain credit and reference information, as it may require and deem appropriate, concerning the statements made within this Application and Guaranty, and agrees that this Application shall remain TRANSYSA's property, whether approved or not. I further agree to pay to TRANSYSA all expenses (including attorney's fees and court costs) paid or incurred by TRANSYSA in collecting such obligations, and in enforcing this Guaranty. Merchant's submission of application acknowledges the receipt  of the Processing Terms and Conditions, and agrees to those terms, conditions, rules, regulations, and operating guidelines. 
 
Copyright © 2005- mycropay. All rights reserved.
Privacy Policy Disclaimer Contact Us Home