Jackrabbit

Tell us about your organization and primary contact

Email(Required)

First Name(Required)

Last Name(Required)

Organization(Required)

Interested in Accepting(Required)

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Country(Required)

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Jackrabbit Org ID

Please share your organization's contact information

Website(Required)

Phone(Required)

Street Address(Required)

Street Address 2

City(Required)

Zip code(Required)

State(Required)

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Province/Territory(Required)

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State(Required)

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Region(Required)

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State(Required)

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Is your legal address the same as your DBA?

Yes

No

DBA Street Address(Required)

DBA City(Required)

DBA Zip Code(Required)

DBA State(Required)

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DBA Province/Territory(Required)

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DBA State(Required)

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DBA Region(Required)

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DBA State(Required)

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Please provide a few more details about your organization

Federal Tax ID(Required)

Business Description

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Years in Business(Required)

Years in Current Address(Required)

Estimated Annual Credit Card Sales(Required)

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Have you accepted credit cards before?(Required)

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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)

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Zip Code(Required)

Business Type(Required)

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

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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

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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

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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
	N/A	2.89%	$0	$.30
	N/A	2.89%	$0	$.30
eCheck Preauthorized Banking Payments	$0	.75%	$0	$.35

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

CAPTCHA

267-369-9729

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