TriSource Solutions LLC—Apply for a Merchant Account

A Merchant Account with TriSource Solutions gives you the pricing, flexibility, and options you want most. We offer multiple solutions to suit your specific business' needs. Whether you're a retail location or an at-home based business, we have the processing solutions you need to provide you a secure and reliable method for transacting payments. Our Customer Service team is always here to serve you timely, courteously, and respectfully—it's what we do. So if you're in need of a new account or just aren't satisfied with your current provider, call today to find out just what a processing relationship can truly be.

To apply now for a Merchant Account, just fill out the form below. It's that easy!

business information

company

Business/Corporate Name:
DBA (Doing Business As) Name:
Location/Site Address 1:
Location/Site Address 2 (optional):
City:
State:
Zip:
Statement Mailing Address (same?):
Legal Organization:
State of Incorporation:
Phone Number (no dashes):	(10 digits only ex. 1234567890)
Email Address:
Website:
Hours of Operation (optional):
How long in present business?:	years/months
Do you currently process credit cards?:
Has business or principal previously been terminated as a Visa or MasterCard merchant?:

merchandise/service

Merchandise/Service Category:
Description of Merchandise/ Service sold:
Description of Refund Policy:
Monthly Estimated Sales Volume: $
Average Sale Amount: $
Highest Sale Amount*: $

*Officers and Owners warrant that the Average Ticket Size and Sales Volume indicated are accurate
and that variances can result in increased fees and delayed and/or withheld settlement funds.

percent of business (must equal 100%)

In-person sales (card is present and swiped at time of transaction):	%
In-person sales (card is imprinted only):	%
Internet/Mail/Phone (card is not present or imprinted):	%

percent sale method (must equal 100%)

Retail Store Front:	%
Off Premise:	%
Mail/Phone Order:	%
Trade Show:	%
Internet:	%
Other:	%
Must consumers provide a deposit for your products or services?
Delivery timeframe of products or services:

equipment and software (skip if you do not currently have equipment)

Terminal/Software:
Terminal Serial Number:
Printer:
Printer Serial Number:
PIN Pad:
Dial Access Code:
If Other (optional):

owner information (owner #1)

Name:
Title:
Residence Address 1:
Residence Address 2 (optional):
City:
State:
Zip:
Phone Number (no dashes):	(10 digits only ex. 1234567890)
Percent Equity Ownership:	%
Driver's License Number:

owner information (owner #2)

Name:
Title:
Residence Address 1:
Residence Address 2 (optional):
City:
State:
Zip:
Phone Number (no dashes):	(10 digits only ex. 1234567890)
Percent Equity Ownership:	%
Driver's License Number:

trade references–two required (reference #1)

Name:
Address 1:
Address 2 (optional):
City:
State:
Zip:
Contact:
Phone Number (no dashes):	(10 digits only ex. 1234567890)

trade references–two required (reference #2)

Name:
Address 1:
Address 2 (optional):
City:
State:
Zip:
Contact:
Phone Number (no dashes):	(10 digits only ex. 1234567890)

existing account information (skip if you do not currently process credit cards)

American Express Merchant Account Number:	(10 digit account #)
American Express Discount Rate:	%
Discover Merchant Account Number:	(15 digit account #)
Discover Discount Rate:	%
Diners Club Merchant Account Number:
Other Merchant Account Name:
Other Merchant Account Number:

By clicking "SUBMIT" each person listed authorizes the Acquirer or any credit bureau or any credit reporting agency employed by the Acquirer or any agent of the Acquirer, to make whatever inquiries the Acquirer deems appropriate to investigate, verify or research references, statements or data obtained from potential Merchant for the purpose of this application. Each person also authorizes the Acquirer to give information to others, including other creditors and credit reporting agencies, concerning the Acquirer experience with Merchant. The Acquirer may also request additional information if the Acquirer decides that is necessary. By submitting your pre-application form, you are giving us permission to perform our standard credit investigation.

Click to submit all information now
Click to reset all fields and start over