Remedy Payment Solutions

Business Owner’s Information:
Name*
First Last
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Cell Phone Number*
Ownership Percentage*
Owner's SSN*
Note: As a financial institution, we are required per the Patriot Act to verify the identity of any individual or corporation opening a new merchant account. A Valid SSN is required.
Owner's DOB*
Month
Day
Year
Driver's License Number
Driver's License Province
Owner's Email Address*
Driver's License Upload
Max. file size: 50 MB.
Is There Another Owner With 25%+ Ownership?*
- Yes
- No
Name*
First Last
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Cell Phone Number*
Ownership Percentage*
Owner's SSN*
Note: As a financial institution, we are required per the Patriot Act to verify the identity of any individual or corporation opening a new merchant account. A Valid SSN is required.
Owner's DOB*
Month
Day
Year
Driver's License Number
Driver's License Province
Driver's License Upload
Max. file size: 50 MB.
Owner's Email Address
Is There Another Owner With 25%+ Ownership?*
- Yes
- No
Name*
First Last
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Cell Phone Number*
Ownership Percentage*
Owner's SSN*
Note: As a financial institution, we are required per the Patriot Act to verify the identity of any individual or corporation opening a new merchant account. A Valid SSN is required.
Owner's DOB*
Month
Day
Year
Driver's License Number
Driver's License Province
Driver's License Upload
Max. file size: 50 MB.
Owner's Email Address

Pre-Application

Step 1 of 4

Credit Card Processing Details

Bank Account Information

Business Owner’s Information:

Authorized Users

Chargeback Contacts

Set-Up Contact

PCI Contact