Pre-Application Form

A fully completed and signed Merchant Processing Application (MPA) is required to establish a merchant processing account. The information provided on this worksheet allows us to prepare the MPA on your behalf. Please ensure all fields have been filled in before sending and feel free to call us at 808-369-9497 ext 1 or email our Hawaii Support Team at [email protected] with any questions.

Your Sales Consultant*
Business Information
Business Name (Doing Business As)*
Location's Address (DBA Address)*
Street Address Address Line 2 City State ZIP Code
Contact Name*
First Last
Contact Email*
Location's Phone Number*
Business Type*
Description of merchandise, products, or services sold*
Business Legal Name as it appears on your Income Tax Return*
Legal/Corporate Phone Number*
Owner's Phone Number or Main Office Number
Years in Business*
Company Website (Optional)
Number of Locations*
Legal/Corporate Address
Leave blank if same as DBA Address

Street Address Address Line 2 City State ZIP Code
Business Financial Information
Estimated Annual Sales Volume (all sources)*
Estimated Annual Credit/Debit Volume*
Average Transaction Size*

monthly sales volume / amount of transactions
Estimated Highest Possible Credit/Debit Sale*
Estimated % of Card-Not-Present Transactions Annually*
Do you do PIN Debit?
- Yes
- No
Do you accept AMEX?
- Yes
- No
Owner/Partner Information
As required by The Patriot Act, please fill out the ownership information below by including any individuals with 24% or more ownership in the business. Once complete, please scroll to the bottom and submit info.
How many people own 24% or more of this business?*
1. Legal Name of Owner/Partner*
First Last
Title*
% Ownership*
Best Contact Phone Number*
Best Contact Email*
Date of Birth*
Month
Day
Year
Home Address*
Street Address Address Line 2 City State ZIP Code
2. Legal Name of Owner/Partner
If another person owns 24% or more, please complete this portion
First Last
Title
% Ownership
Best Contact Phone Number
Best Contact Email
Date of Birth
Month
Day
Year
Home Address
Street Address Address Line 2 City State ZIP Code
3. Legal Name of Owner/Partner
If another person owns 24% or more, please complete this portion
First Last
Title
% Ownership
Best Contact Phone Number
Best Contact Email
Date of Birth
Month
Day
Year
Home Address
Street Address Address Line 2 City State ZIP Code
4. Legal Name of Owner/Partner
If another person owns 24% or more, please complete this portion
First Last
Title
% Ownership
Best Contact Phone Number
Best Contact Email
Date of Birth
Month
Day
Year
Address
Street Address Address Line 2 City State ZIP Code
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Pre-Application Form

Business Information

Business Financial Information

Owner/Partner Information

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