Integrated Payments with ACHQ
Please answer the following questions about your business. You’ll be asked to provide information to verify the business and identity of the primary business contacts. This form should take you about 10 minutes to complete.
Step 1 of 2
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Business Details
The information you provide below will help us verify and understand your business.
Business Name
*
Legal Business Name
*
.
Tax ID
*
Employer Identification Number (EIN)
Phone
*
LLC
Partnership
Corporation
Sole Proprietor
Non-Profit
Business Type
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State of Incorporation
*
Primary Email
*
Website
*
Business Description and Target Verticals
*
In a few sentences, describe your customers and the products or services you offer as well as your specific use of ACH payments.
Customer Service Phone
*
Customer Service Email
*
Business Address
Main Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Authorized Representative
Your ACHQ account needs to be activated by someone with significant management responsibility or control over your company. If that’s not you, please ask an authorized executive, senior manager, or business owner from your company to complete this form.
Name
*
First
Last
Title
Email
*
Work Phone
*
Cell Phone
*
Banking Details
Bank Name
*
Routing Number
*
Account Number
*
That's it!
Just sign below to get started with ACHQ
I consent to the
ACHQ Partner Terms
, the
Acceptable Use Policy
, and the
Electronic Signature Terms
.
Typed Name of Signor
*
Please Sign Below
*
Date Format: MM slash DD slash YYYY
Date Signed
Email
This field is for validation purposes and should be left unchanged.