raisin

Tell us about your organization and primary contact

Email(Required)

First Name(Required)

Last Name(Required)

Organization(Required)

Interested in Accepting(Required)

Country(Required)

Preferred Language

Please share your organization's contact information

Website(Required)

Phone(Required)

Street Address(Required)

Street Address 2

City(Required)

Zip code(Required)

Postal code(Required)

State(Required)

Province/Territory(Required)

State(Required)

Region(Required)

State(Required)

Is your legal address the same as your DBA?

Yes

No

DBA Street Address(Required)

DBA Street Address 2

DBA City(Required)

DBA Zip Code(Required)

DBA Postal code(Required)

DBA State(Required)

DBA Province/Territory(Required)

DBA State(Required)

DBA Region(Required)

DBA State(Required)

Please provide a few more details about your organization

Federal Tax ID(Required)

Business Description

Years in Business(Required)

Years in Current Address(Required)

Estimated Annual Credit Card Sales(Required)

Have you accepted credit cards before?(Required)

Where should we deposit your funds?

Checking Account Routing Number(Required)

Re-enter Checking Account Routing Number(Required)

Re-enter Checking Account Account Number(Required)

My billing account is the same as my deposit account(Required)

Yes

No

Billing Routing Number(Required)

Re-enter Billing Routing Number(Required)

Billing Bank Account Number(Required)

Re-enter Billing Bank Account Number(Required)

I will provide my bank account and routing number at a later time.

Who is the Authorized Signer for your business?

Authorized Signer's Last Name(Required)

Authorized Signer's SSN(Required)

Authorized Signer's Date of Birth(Required)

Street Address(Required)

Street Address 2

City(Required)

State(Required)

Zip Code(Required)

Postal code(Required)

Business Type(Required)

How many owners have 25% or more equity ?(Required)

Does the authorized signer also own more than 25% or more of the business ?(Required)

Yes

No

Owner #1

% of Ownership

Owner's First Name

Owner's Last Name

Owner's Title

Owner's Phone Number

Owner's SSN

Owner's DOB

Owner's Street Address

Owner's Street Address 2

Owner's City

Owner's State

Owner's Zip code

Owner #2

% of Ownership

Owner's First Name

Owner's Last Name

Owner's Title

Owner's Phone Number

Owner's SSN

Owner's DOB

Owner's Street Address

Owner's Street Address 2

Owner's City

Owner's State

Owner's Zip Code

Owner #3

% of Ownership

Owner's First name

Owner's Last Name

Owner's Title

Owner's Phone Number

Owner's SSN

Owner's DOB

Owner's Street Address

Owner's Street Address 2

Owner's City

Owner's State

Owner's Zip Code

Owner #4

% of Ownership

Owner's First name

Owner's last Name

Owner's Title

Owner's Phone Number

Owner's SSN

Owner's DOB

Owner's Street Address

Owner's Street Address 2

Owner's City

Owner's State

Owner's Zip Code

Who will be the primary user of your merchant account?

Same as primary contact.

Same as authorized signer

Processing Contact Name(Required)

Processing Contact Email(Required)

I accept the processing rates and Terms of Service for SafeSave Payment Services

A representative will reach out to you via email in 1-2 business days.

Please confirm that you accept the following

	SETUP FEE	RATE	MONTHLY FEE	PER TRANSACTION
		2.89%	$0	$0.30
		3.39%	$0	$0.30
eCheck Preauthorized Banking Payments	$0	0.75%	$0	$0.35

	SETUP FEE	RATE	MONTHLY FEE	PER TRANSACTION
		2.89%	$0	$0.30
		3.39%	$0	$0.30
eCheck Preauthorized Banking Payments	$0	0.75%	$0	$0.40

I accept the processing rates and Terms of Service for SafeSave Payment Services

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800-220-8611

SafeSave Payment Services

Tell us about your organization and primary contact

Please share your organization's contact information

Please provide a few more details about your organization

Where should we deposit your funds?

Who is the Authorized Signer for your business?

Owner #1

Owner #2

Owner #3

Owner #4

Who will be the primary user of your merchant account?

You have completed your application form!

Please confirm that you accept the following