Merchant Signup
888-622-5729
Merchant Full Name
(Required)
First
Last
The Merchant is the store or business owner who will being accepting payments
Merchant Email Address
(Required)
Merchant Phone Number
(Required)
Are you a Merchant or Sales Representitive
(Required)
I am a Merchant
I am a Sales Representitive
Sales Representitive Code
(Required)
Sales Representitive Email
(Required)
Business Information
Business Legal Name
(Required)
Business DBA Name
(Required)
Tax ID
(Required)
Type of Business
(Required)
Please Select
Sole Trader
LLC
Corp
Partnership
Nature of Business
(Required)
Business Address
(Required)
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Select a State
ZIP Code
Business Phone
(Required)
Business Email
Processing Information
What product(s) would you like to sign up for
(Required)
Traditional Processing
Zero Fee Processing / Cash Discount Program
E-Commerce Processing / Virtual Terminal
What device would you like to process your payments?
(Required)
Standalone Terminal
Wireless Terminal
OrangePay Point of Sale System
Clover Point of Sale
I'm unsure, please contact me
Which software would you like to integrate with?
(Required)
Shopify
Woocommerce
Magento
OpenCart
Virtual Terminal Only
Custom API
Other
I'm unsure, please contact me
Transactional Information
Please enter the $ amount below
Ticket refers to each individual transaction
Average Ticket Value
(Required)
Highest Ticket Value
(Required)
Estimated Monthly Turnover
(Required)
Agent Specific Pricing
Would you like to enter pricing for the Merchant now?
(Required)
Yes, I will enter pricing now
No, please will the office contact me for assistance
Please complete the box below with the billing structure for this client
Things to conciser
- interchange Plus
- What are the fees
- What are the monthly costs
- What are the costs of the terminals
- What is the rate for cash discounting?
Fee Structure
(Required)
Owner Personal Information
Position / Title
(Required)
Ownership Percentage
(Required)
Date of Birth
(Required)
Month
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Day
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Year
2023
2022
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Social Security Number
Is your residential address the same as your business?
(Required)
Yes
No
Residential Address
(Required)
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have a copy of a void check or bank account letter?
(Required)
Yes, upload now
No, I will email it to you
Upload void check / bank account letter
(Required)
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 5 MB.
No problem. Once this form has been submitted, we will send you an email. Please check your spam!
Simply reply to the email and attach a copy of your Void Check or Bank Account Confirmation Letter
Owing to you processing more than $1,000,000 per year - we require some further documentation.
Please send us a copy of a 3 month bank statement and a 3 month processing statement (if applicable)
Will you upload these files now?
(Required)
Yes, upload now
No, I will email it to you
Upload bank statement and merchant statement
(Required)
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 5 MB.
No problem. Once this form has been submitted, we will send you an email. Please check your spam!
Simply reply to the email and attach a copy of your bank statement and merchant processing statement
Where did you hear about OrangePay?
(Required)
Google / Search Engine
Facebook/Instagram
Referral from Friend
Agent Called Me
I saw OrangePay in a Store
I am an OrangePay Sales Rep
Other
Optional: Is there anything else you would like to add?
Name
This field is for validation purposes and should be left unchanged.