eNovaPay - Merchant Account Application

Business Information

Legal Business Name

DBA (Doing Business As)

Business Type

Federal Tax ID (EIN)

Business Phone

Business Email

Business Website

Business Address

City

State

ZIP Code

Date Business Started

Industry / Business Category

Products/Services Description

Owner / Principal Information

First Name

Middle Name

Last Name

Title

Ownership %

Date of Birth

SSN

Driver's License #

Owner Phone

Owner Email

Home Address

City

State

ZIP

Processing Information

Estimated Monthly Volume ($)

Average Ticket ($)

Highest Ticket ($)

Current Processor

Transaction Breakdown (%)

Card Swiped / Dipped %

Keyed-In %

E-Commerce %

Total must equal 100%

Do you accept recurring payments?

Do you store card data?

Refund Policy

Delivery Timeframe

Bank Account Information

Bank Name

Routing Number (ABA)

Account Number

Account Type

Name on Account

Document Uploads

Please upload the required documents. Accepted formats: PDF, JPG, PNG (max 5 MB each).

Business License / Registration

Click or drag file here

PDF, JPG, PNG — max 5 MB

Voided Check / Bank Letter

Click or drag file here

PDF, JPG, PNG — max 5 MB

Government-Issued ID (Front)

Click or drag file here

PDF, JPG, PNG — max 5 MB

Government-Issued ID (Back)

Click or drag file here

PDF, JPG, PNG — max 5 MB

Recent Processing Statements (3 months)

Click or drag files here

PDF — max 5 MB each (multiple)

Additional Documents

Click or drag files here

PDF, JPG, PNG — max 5 MB each (multiple)

Review & Submit

Electronic Signature

I certify that all information provided is true and accurate. I authorize the processing company to verify the information and perform background checks as necessary. I agree to the Terms & Conditions.

I acknowledge and agree to the Privacy Policy.