Signup for Corepayments today! Learn About CorePayments Fill out the form below to get applied for your merchant account with CorePayments! Civis Bank - PreMPA - Non SC Business InformationAll information provided on this page is confidential and processed internally by our in-house team.What industry best first your business?*Please SelectAuto/IndustrialCrafts/GiftsElectronicsFashion/ApparelFood/DrinkHealth/BeautyHome Decor/GardenJewelryMusicOtherSports/OutdoorsToys/Kids/BabyI sell:*Please SelectB2B - Business-to-BusineesB2C - Business-to-ConsumerBoth B2B and B2CLegal Name of Business* DBA Business Name* *Doing Business AsDBA Phone Number* Domain Name of Website* Physical Address of BusinessAddress 1* Please enter your business' street address. PO Boxes are not allowed on the application. Address 2 City* State*Please Select*InternationalAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code* Type of Business*Please SelectC Corporation Closely HeldC Corporation Private CompanyC Corporation Public CompanyEstateGeneral PartnershipGovernmentLLCLimited PartnershipSole Prop.Sub S Corp.Tax Exempt OrganizationTrustUnincorporated Assoc.Federal Tax ID Number* Month and Year Business Started* MM slash DD slash YYYY Description of Products and Services of BusinessEmail* Estimated Monthly Credit Card Volume*Average Transaction Amount*Home Address of Person Signing PaperworkTitle of Person Signing Paperwork*OwnerCEOCFODirectorGeneral ManagerAuthorized SignorPresidentVice PresidentTreasurerOtherIf Other, please describe Full Name of Person Signing Paperwork* P.O. Box addresses are NOT accepted. 1a.If you are providing a personal home addresses you will need to provide a valid copy of your driver license, utility bill, bank statement or lease agreement.Address 1 of Person Signing Paperwork* Please enter your business' street address. PO Boxes are not allowed on the application. Address 2 of Person Signing Paperwork City of Person Signing Paperwork* State of Person Signing Paperwork*Please Select*InternationalAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code of Person Signing Paperwork* Phone Number of Person Signing Paperwork* A valid Social Security ID # is required due to regulations in fraud prevention. 1a. If you are signing on behalf of a Business, Corporation, Entity, etc.. your social security will only be used for verification on account signup. 1b. This rule applies only for signors NOT signing the personal guarantee.SSN Number of Person Signing Paperwork* Birth Date of Person Signing Paperwork* MM slash DD slash YYYY Bank Account InformationBank Name* Bank Routing Number* Bank Account Number* CommentsUpload Files Drop files here or Select files Accepted file types: jpg, png, xlsx, csv, pdf, zip, Max. file size: 50 MB. CAPTCHA
