Contact form

<h3>Get started with your merchant application</h3>
<p class="large"><br />Fill out our secure Merchant Intake Form to get started with your merchant application. </p>
<p class="large">Your agent will be contacting you once you have submitted your information. </p>

name

email

Legal Business Name

Ownership Type

Sole Proprietor

Corporation

DBA Name

Tax ID/ EIN

Legal Business Address

Goods/ Services your business provides

Residential Address

Phone Number

Date of Birth

How do you need to process credit card payments?

Online

Over the phone/ invoicing

In person

How much do you need to process on a monthly basis?

Bank Account Number

Bank Routing Number

message

Boost Merchants

merchant services

Hanken Grotesk

Roboto