High Risk Merchant Account Application
Merchant-Account-High-Risk.Com Application Form
If you would like to be contacted in person, please just fill out the required information section. If you would like to apply online then please complete the entire form. All the information will be kept strictly confidential and will only be shared with our acquiring bank for merchant account approval.
If you have any questions feel free to call us at (888) 875-2785 and request extension 12-IWBC If you prefer to fax in your applications, call us for the current fax number.
Required Information
* Business Phone
* Email Address
Are you interested in a hosting service?
Personal Information
Business Information
Please Check which products and services you are interested in:
Business Type: Corporation, LLC, etc
Description of Products Sold:
Marketing Method
Percent Mix (must equal 100)Please do not include the % symbol
% Retail % Mail Order % Trade Show % Service % Internet % Other
Do you currently accept Visa or Mastercard? Yes No
If no, expected monthly credit card volume
How did you hear about us?
Comments or Messages