Merchant Account Application - HRMA-LLC
* indicates required
Secure Online Application
     STEP ONE             Business Info

Email Address*
Legal Business Name*
DBA Name
Business Location
City State Zip
Business Form
Business EIN #
Confirm EIN# EIN is 100% Correct Dont Have One
Business Phone
Business Fax
Website Address
Describe Products
Average Sale Price
Monthly Card Volume
Transaction Type Face-To-Face SWIPED Phone Orders KEYED eCommerce Sales
Accept Cards Now Yes Currently Processing Processing Closed Never Processed
Current Statements
Business Start Date
STEP TWO  Owner Information
Owners Name*
Home Address
City State Zip
Principal's Title
Ownership %
Drivers License#
Credit Score
Social Security#
Date Of Birth
Cell Phone*
Best Time To Call Morning Afternoon Evening
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