Let’s Get Started Pre Approve Application Step 1 of 7 - Company Information 0% How would you like to Accept Credit Cards?* Retail or In-person Mobile or On the Go Mail or Telephone Order Email Invoice eCommerce or Website Industry* Product or Service Business Name* How long in business?*0 to 6 Months6 Months to 1 Year1 Year to 3 Years3 Years to 5 Years5 Years or MoreSelect Mobile Device* Cell Phone Tablet Cell Number* Wireless Provider Name?* Monthly Credit Card Amount*Average Ticket Amount*Highest Ticket Amount*Any additional services you would like to inquire about? Shopping Cart or eCommerce Point of Sale Systems CRM Integrated Software Recurring or ACH eChecks QuickBooks' or Sage Accounting Electronic Benefit Transfer (EBT) Inventory Management Gift & Loyalty Cards Marketing or Reporting Multi Location Merchant Cash Advance Global Processing Non-Profit Organization 501 (c)(3) Level ll & Level lll Processing How did you hear about our company?GoogleExisting ClientFamily or FriendsBingSocia MediaTelephone or EmailNewspaperNon-Profit AffiliationOtherReferral Name or Organization Is this business seasonal? No Yes Do you have any additional questions or concerns with your day to day operations? Name* First Last Date of Birth* MM slash DD slash YYYY Social Security #* Email* Business Phone Number*Website Tax ID or EIN* Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Company Open Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Attach Voided Check & Driver License Drop files here or Select files Max. file size: 128 MB. Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Legal Entity*Sole Proprietor/IndividualPartnershipCorporationLimited Liability CompanyNon Profit OrgGovernment (Federal/State/Local)Association/Estate/TrustFinancial InstitutionRefund Policy*No Refund or ExchangeExchange OnlyRefund in 30 days or lessMore than 30 daysAccept American Express*YesNoDBA Name* Home Phone Number* By clicking submit, you agree that Reli Solutions may contact you to assist with your request.By clicking submit, you agree that Reli Solutions may contact you to assist with your request.CommentsThis field is for validation purposes and should be left unchanged.
