Merchant Account Application

Official Discover Merchant Account Application

If you have a MasterCard/Visa Merchant Account already, and you want to apply for a Discover Card Merchant Number Please fill out this form, and you will receive a Discover Card Acceptance Package in the mail within 2 weeks. If you have any questions, please call 1-800-893-6001.

The application is FREE and Discover does not charge a monthly statement fee. Discount rates are competitive with you current rate for MasterCard and Visa. If you need a rate quote in advance, please call (800) 893-6001.

Business Information:

Legal Business Name 
   DBA Name 
  Location Address 
   City, St, Zip 
 Phone  Fax 
   E-mail 
 Web-Site (if Internet Account)
 
Partnership Corporation Sole Proprietorship
 Federal Tax ID   Years In Business

Checking account information:
List where you would like your funds to be deposited:
Bank Name, Branch
Account Number Routing Num.

Personal information:
Principal Name
Title % Percentage ownership
Home address
City, Sate, Zip
Years at current address
Previous Address (if less than 3 years)

Home Phone Date of Birth
Social Security #
Drivers License # State of issue Exp
One Credit Reference
Address
City, State, ZipPhone
Phone

Marketing Method (Must equal 100%)

Type of Business
Retail % Mail Order % Trade Show % Service %
Internet % Other %
Do you currently accept credit cards? Yes No
Apx. Monthly Card Volume $ Average Sale $
Has any of the principals of this organization ever had a bankcard relationship terminated for any reason?