How do I sign up?

Batch Out will take immediate action in order to qualify your business through an underwriting process that will ensure an aggressive rate and streamlined processing needs, all while keeping security a priority.

Once our office receives the populated form below we will either fax or email you your application and conduct a site survey. Upon receipt of the executed application you will be able to start processing. Normal approval and up and running timeframes are within 72 hours, although sooner is possible depending on credit history.

Merchant Services Set-Up Requirement Form

The fields below are necessary in order to accept credit cards. Please fill in the requested information and fax company financials if available. Most importantly, include a copy of a voided check with business name and address printed on it (not a temporary check) where you would like your funds deposited into. This information will be used to populate the official application.

Company Information ( * indicates required field )

Member Group :	( Name of: Trade Association, POS, Bank, Web Developer, Sales Agent or how you heard about Batch Out )
DBA Name:*
DBA Address:*
DBA Address 2:
DBA City:*
DBA State:*
DBA Zip:*
Business Name ( same as on your business check ):*
Business Phone:*	() - -
Business Fax:	() - -
E-mail Address:*
Would you like your statements mailed or emailed to you?*
Tax ID of Business ( 9 digits long ):*	501(c)3 #
Date Business Began:*

Owners


Signor(s) Name:*		% of Ownership*	%
Title:*
Home Phone:*	() - -
Address:*
Address 2:
City:*
State:*
Zip:*
Own or Rent?*		How long have you lived at your current address?*
If less, than 1 year what was your previous address?
Previous Address, Own or Rent?		How Long did you live at your previous address?
OPTIONAL
Signor(2) Name:		% of Ownership
Title:
Home Phone:	() - -
Address:
Address 2:
City:
State:
Zip:
Own or Rent?		How long have you lived at your current address?
If less, than 1 year what was your previous address?
Previous Address, Own or Rent?		How Long did you live at your previous address?

Signor(1) Social Security Number*		Date Of Birth* (mm/dd/yyyy)
Signor(2) Social Security Number		Date Of Birth (mm/dd/yyyy)

Current Business Sales

Annual Visa/Mastercard Volume:*

Average Credit Card Sale:*

Total Sales:*

Describe the merchandise sold or service provided:*

Annual Credit Card Sales Generated By:*

Mail/Phone:	%	Card Swipe:	%
Internet:	%	Hand-Keyed:	%

American Express Merchant Number if already accepting AMEX:

If you already own your own credit card terminal or POS, identify the make and model:

New Clients

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