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High Risk Merchants

*Company Name:


* Required Fields

*Doing Business As:


Email:


*Phone:


*Address:


*City:


*State/Province:


*Zip Code:


*Country:


*Web Site:


*Business Type:


Please Indicate your business type
from the:List of Approved HIGH RISK
Merchant Categories The industry you are in (supermarket, restaurant,
salon, retail, etc...)

*Describe your businesss:


Years in Business:


Additional Information to
connect to your
website(ie:user/password..):


Estimated monthly VISA/MC
volume:


Average Ticket:


Highest Ticket:


*Have you ever processed Credit
Cards before?
Yes
No

*Reasons for requesting account:
TMF
New Business
Poor Credit Score
High Chargebacks
Capped Volume
Unknown

*How do you plan to process
credit cards?
Retail
Wireless
Moto
Manually Swiped
Internet
Other

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