AlliedPayments Full Application Form

Allied Payments Application

Fields Marked with * are Required

First Name

Last Name

Website

Legal Company Name

Legal Company Address

Legal Company Phone Number

Company Tax ID / EIN Number

Business Start Date

DBA Descriptor

Is The Business Physical Address Different?

Yes

Company Location Address - Different

Is The Company Manager Different From The Owner?

Yes

Company Manager Name

Company Manager Email

Type of Payment Processing Required

Estimated Monthly Sales Volume

Estimated Average Transaction Amount

Estimated Highest Transaction Amount

Owner / Account Signer 1: Full Name

Owner / Account Signer 1: Home Address

Owner / Account Signer 1: Mobile Number

Owner / Account Signer 1: Email Address

Owner / Account Signer 1: Date of Birth*

Owner / Account Signer 1: Estimated Credit Score

Does The Business Have a Second Owner?

Yes

Signer/Owner 2: Full Name

Signer/Owner 2: Mobile Number

Signer/Owner 2: Date of Birth*

Signer/Owner 2: Home Address

Signer/Owner 2: Email Address*

Signer/Owner 2: Estimated Credit Score

How Did You Find Allied Payments?*

I agree to receive communications by email, phone and text message from Allied Payments about my application inquiry.

Allied Payments Application

Quick Links

Resources

Contact Us

Allied Payments®

1-800-315-5755

[email protected]

Quick Links

Resources

CONTACT US

Allied Payments®

1-800-315-5755

[email protected]