Offshore Merchant Account

Please complete the following application with all information that applies to you for your new bank account. If you wish to order more services, you will be given that option after submitting this form.

IMPORTANT: The following application will provide us with enough information to finalize the forms for your account, therefore saving time in the underwriting process. Completing this application DOES NOT commit you to the account, and ALL information is kept confidential and stored on our secure servers for a minimal amount of time.



Merchant Information

Legal Name of Business
Type of Ownership	Select Ownership Type Sole Proprietorship Partnership Public Corporation Private Corporation Limited Liability Company Non-Profit Corporation Medical or Legal Corporation Association/Estate or Trust Tax Exempt Organization (501C) Gov. (Federal/State/Local) International Organization International Business Company Other
DBA Name (if applicable)
Federal Tax ID (if applicable)
Country of International Business Co. (if applicable)
Date Business Started
Number of Locations
Years at Current Location
Number of Employees
Contact Business Title
*Contact Name
*Contact Surname
*Contact E-mail
*Contact E-mail Confirmed
*Telephone
Mobile Telephone
Alternative/Business Telephone
Best Time to Call
Facsimile
*Address
Address
*City
*State/Province
*Postal/Zip Code
*Country
Physical Business Address (if different from above)
Name
Address
Address
City
State/Province
Postal/Zip Code
Country
Telephone

Business Model Information
(IMPORTANT: your answers to the following questions will NOT affect whether you get an account--they are just to help us understand what your processing needs are and what barriers, if any, we will have to cross in order to obtain an account for you).

Description of Product/Service Sold (please be specific)


How many days from the date of purchase does it take for the customer to receive their product or service?

Refund Policy

Where are your Target Markets?

What are your Marketing Methods?

Processing Information

Reference Information
(Reference information can be of an attorney, accountant, or any other person or entity to whom your business has paid for services relating to the business).

Reference 1

Reference 2

Bank Reference
*Bank info will be used as reference only.

Principal/Owner Information

Owner 1

Owner 2 (if applicable)

Technical Information

3-5 Features
(Please list below, 3-5 features you would like your Merchant Account to offer)
1.
2.
3.
4.
5.