Independent Sales Agent
Costa Mesa, CA

(800) 889-8822

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Filling out this application does not constitute a complete application process. However, it will use the information to provide a recommendation for the credit services you need for your business. It will also enable us to correctly identify the methods you use to accept credit cards and the percentage you use them. This allows us to calculate the risk involved and provide you with an accurate quote of the fees you will be charged.
* indicates a required field.
Business Information
*Business Name
*DBA (Doing Business As) Name
Business Address (no P.O. Box)
Address 2
Business City
Business State
Business Zip Code
Business Phone
Business Ext.
Business Fax
Tell Us About Your Business
Describe Products Sold*
Estimate how you will accept credit cards:
Swiped
%
Imprinted
%
Card Not Present
%
How you conduct your business
Years or Months in Business
Home Business?
Primary Contact Information
Contact Name*
Contact Phone*
Ext
Email
Business Website URL
Card Processing
Check additional services interested in (check all that apply):


Estimated Average Sale/Ticket Amount
Estimated Average Monthly Volume
Estimated Highest Sale $
Do you currently accept credit cards for this business?
Are you an existing AMEX Merchant?
If yes, do you wish to use the same number for this business?
Are you an existing Discover Merchant?
If yes, do you wish to use the same number for this business?
Owner Information
Owner Name
Title or Relationship
Owner Home Address
Home City
Home State
Owner Home Zip Code
Owner Home Phone
Referral Information
How did you hear about Ignite Payments?
Name of individual, organization or institution referring you?
Comments
DO NOT INCLUDE ANY BANK NUMBER OR ANY OTHER SENSITIVE INFORMATION.
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Form Help

Only certain fields are required to submit this form and are noted with an asterick (*), but to help us prepare before we call or email you, please enter as much information as possible.

redhelp1.gifBusiness Name - This is the official legal entitiy name for your business .

redhelp1.gifDBA - Doing Business As:  The alias you used to register your business with the local city or county.  In order to apply for a merchant account under this DBA, your bank must recognize this name as well.

redhelp3.gifDescribe Products/Services Sold - A brief explanation of what your business sells.  This helps us determine the Standard Industry Code 'SIC' of your business
 

redhelp4.gifEstimate How you will Accept Cards
Swiped
- The percentage of credit cards will be physically swiped through an electronic processing terminal and you will be able to verify the cardholders' identity with other supporting IDs.

redhelp5.gifImprinted - The percentage of credit cards that an imprint of the card will be taken for later manual entry into credit card processing system.  You will be able to verify the cardholders' identity with other supporting IDs.

redhelp6.gifCard Not Present - The percentage of credit cards that you will be taking the card numbers and expiration dates over the phone, through the mail order, or over the Internet and will not be able to personally verify the customer's indentity.

redhelp7.gifHome Business - You operate your business from your home and have no other permanent business location.

 
redhelp8.gifEstimated Average Ticket - This is what a typical sale would be that is charged on a credit or debit card.

redhelp9.gifEstimated Monthly Volume - What you anticipate you will be processing per month within the first six to eight months of processing.  Underwriting reviews you and your business credit history combined with the estimated monthly volume for approval.  Requests for additional volume need to have a miniumum of six months of processing to review.

redhelp10.gifEstimated High Ticket - What a potential high ticket might be.   The requested monthly volume should be higher than an estimated High Ticket.