A fully-integrated electronic check solution
Just fill out the form below to eliminate manual billing and payment reconciliation.
"
*
" indicates required fields
Step
1
of
4
25%
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Send Plaid Email
Yes
No
Business Details
Legal business name
*
Tax ID
*
Doing business as
*
This name will appear on your customer's statements.
Industry
*
Accounting
Airlines/Aviation
Alternative Dispute Resolution
Alternative Medicine
Animation
Apparel & Fashion
Architecture & Planning
Arts and Crafts
Automotive
Automotive Lending
Aviation & Aerospace
Banking
Biotechnology
Blockchain
Broadcast Media
Building Materials
Business Lending
Business Supplies and Equipment
Capital Markets
Chemicals
Civic & Social Organization
Civil Engineering
Commercial Real Estate
Computer & Network Security
Computer Games
Computer Hardware
Computer Networking
Computer Software
Construction
Consumer Electronics
Consumer Goods
Consumer Lending
Consumer Services
Cosmetics
Cryptocurrency
Dairy
Defense & Space
Design
Education Management
E-Learning
Electrical/Electronic Manufacturing
Entertainment
Environmental Services
Equipment Rental
Events Services
Executive Office
Facilities Services
Farming
Financial Services
Fine Art
Fintech
Fishery
Food & Beverages
Food Production
Fund-Raising
Furniture
Gambling & Casinos
Glass, Ceramics & Concrete
Government Administration
Government Relations
Graphic Design
Health, Wellness and Fitness
Higher Education
Hospital & Health Care
Hospitality
Human Resources
Import and Export
Individual & Family Services
Industrial Automation
Information Services
Information Technology and Services
Insurance
International Affairs
International Trade and Development
Internet
Investment Banking
Investment Management
Judiciary
Law Enforcement
Law Practice
Legal Services
Legislative Office
Leisure, Travel & Tourism
Libraries
Logistics and Supply Chain
Luxury Goods & Jewelry
Machinery
Management Consulting
Maritime
Marketing and Advertising
Market Research
Mechanical or Industrial Engineering
Media Production
Medical Devices
Medical Practice
Mental Health Care
Military
Mining & Metals
Motion Pictures and Film
Museums and Institutions
Music
Nanotechnology
Newspapers
Non-Profit Organization Management
Oil & Energy
Online Media
Outsourcing/Offshoring
Package/Freight Delivery
Packaging and Containers
Paper & Forest Products
Payday Lending
Performing Arts
Pharmaceuticals
Philanthropy
Photography
Plastics
Political Organization
Primary/Secondary Education
Printing
Professional Training & Coaching
Program Development
Public Policy
Public Relations and Communications
Public Safety
Publishing
Railroad Manufacture
Ranching
Real Estate
Recreational Facilities and Services
Religious Institutions
Renewables & Environment
Research
Restaurants
Retail
SaaS
Sales Financing
School or University
Security and Investigations
Semiconductors
Shipbuilding
Software Development
Sporting Goods
Sports
Staffing and Recruiting
Supermarkets
Telecommunications
Textiles
Think Tanks
Tobacco
Translation and Localization
Transportation/Trucking/Railroad
Utilities
Venture Capital & Private Equity
Veterinary
Warehousing
Web Development
Wholesale
Wine and Spirits
Wireless
Writing and Editing
Type of business
*
LLC
Partnership
Corporation
Sole Proprietor
Non-Profit
Website
*
Phone
*
Business and product/service description
*
Describe your customers and the products or services you offer.
Business address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contacts and Owners
Beneficial Owner Name
*
First
Last
This must be an individual with greater than 25% ownership or significant management responsibilities (CFO, CTO, etc.)
Job title
*
Email
*
Cell phone
*
Social Security Number
*
Ownership Percent
*
Date of birth
*
MM slash DD slash YYYY
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Add an additional company representative?
Yes
No
Authorized Representative
Name
First
Last
Title
Email
Company Phone
Does this individual own 25% or more of the business?
Yes
No
Social Security Number
Ownership Percent
Payment Processing
Tell us about your current and projected processing volume.
Dollars / month
*
Transactions / month
*
Max single transaction
*
Max daily amount
*
Returned transaction %
*
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Average Transaction Amount
*
Customer types
*
Consumer
Business
Transaction types
*
Debits
Credits
Authorization method(s)
*
PPD
CCD
WEB
TEL
How to authorize ACH
ACH Descriptor
*
We already pass along your company name and phone number, so consider some other value here.
Customer service phone
*
This number will appear on your customer's statements
Customer service email
*
Use of ACH
*
Examples include payroll, service fees, sale of goods, subscription fee, tuition, etc.
Refund/Return Policy
*
Financing/Loan Details
Funding Recpient
Direct to Consumer
Direct to Business
Sales Financing
Average Loan Amount
Average Loan Term
Average Loan APR
Max Loan Amount
Max Loan Term
Max Loan APR
Banking Details for Settlements
Bank name
*
Routing number
*
Account number
*
Use this account for fees?
*
Yes
No
Billing Bank Account Details
Where you want your fees debited
Billing bank name
Billing routing number
Billing account number
Signature and agreement
Agreement
I consent to the
ACH Payment Services Agreement
, the
Acceptable Use Policy
, and the
Electronic Signature Terms
, and I am providing written instructions under the Fair Credit Reporting Act authorizing ACHQ, to obtain and use information from my personal credit report to process this application.
This inquiry will not affect your credit score.
Signature
Typed name of signee
Signature
Email
This field is for validation purposes and should be left unchanged.
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