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Pre-Application

BELLNIK Payments Inc

Find Freedom in Payments

Home
Business Solutions
Contact Us Today
How We Do It Better
Partner with Us
Pre-Application

Home Pre-Application

Pre-Application

Please complete this application if you are interested in a new merchant account with us!

We will contact you with in 24 hours of receiving your Pre-Application.

Legal Business Name *

DBA (if Applicable)

Name *

First

Last

Contact Phone Number *

Contact Email *

Email

Confirm Email

Business Address *

Business Phone Number *

Business Email *

Email

Confirm Email

Website Address *

Business EIN *

High Ticket *

Monthly Volume *

Average Ticket *

Business Start Date *

Signer #1 Name *

First

Last

Signer #1 DOB *

Signer #1 SSN *

Signer #1 Contact Number *

Signer #1 Email Address *

Email

Confirm Email

Signer #1 Ownership % *

Signer #2 Name

First

Last

Signer #2 DOB

Signer #2 SSN

Signer #2 Contact Number

Signer #2 Email

Email

Confirm Email

Signer #2 Ownership %

Additional Information you would like to provide

Are you currently processing credit cards?

Yes
No

Would you consider your business to be High Risk?

Yes
No

What percentage of your business is online?

Message

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