Apply for a High Risk CC Account
Merchants can complete this PreCheck form* to save time and effort.

With the info you provide, we can determine whether we can assist you with obtaining your credit card merchant account(s). If your PreCheck is approved, we ask you to proceed and complete our application form.

Contracting Company Name *

DBA name (if applicable) *

Company Address *

Country of Incorporation *

Email Address *

Business Phone *

Official Owner / % owned *

Name of CEO *

Years in Business *

Merchant Business Type

Detailed Description of Products/Services Sold *

Describe Pricing, Membership Packages and Service Lengths

Is a Fulfillment House Used? *

 Yes No

Is a Call Center Used? *

 Yes No

URL(s) that will be used
(include login and password if applicable)

Current Processor

How Long with Current Processor/Acquirer

Average Transaction Value

Monthly Processing Volume

Desired Processing Currencies

Desired Settlement Currencies

Transactional History *
Last Month
2 Months ago
3 Months ago
4 Months ago
5 Months ago
6 Months ago
* All Fields are required.