Easily Collect Payments Online
With Quik.Pay you can collect payments before the customer returns to pick up the car and help them remember you for the great service, not the bill.
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 3
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Business Details
The information you provide below will help us verify and understand your business.
Business Name
*
Legal Business Name
*
.
LLC
Partnership
Corporation
Sole Proprietor
Non-Profit
Business Type
*
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
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
Industry
*
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
*
Tax ID
*
Employer Identification Number (EIN)
Date Format: MM slash DD slash YYYY
Business Start Date
*
Phone
*
Website
Primary Email
*
Business Description
*
In a few sentences, describe your customers and the products or services you offer.
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 Quik.Pay 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
*
Does this individual own 25% or more of the business?
*
Yes
No
Is this individual the primary owner?
Yes
No
Social Security Number
Date Format: MM slash DD slash YYYY
Birthdate
Ownership Percent
Company Ownership Information
Due to government regulations, we’re required to collect information about a company’s primary owner.
Name
*
First
Last
Title
*
Email
*
Cell Phone
*
Social Security Number
Date Format: MM slash DD slash YYYY
Birthdate
*
Ownership Percent
*
Home 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
Credit Card Processing
Tell us about your projected Quik.Pay processing volume.
Dollars per Month
Average Transaction Amount
Max Transaction Amount
0
1
2
3
4
5
6
7
8
9
10+
How many stand-alone credit card terminals are being replaced?
Customer Service Phone
*
Customer Service Email
*
Banking Details for Settlements
Please provide a checking account that settles in USD ($). Funds are typically disbursed within 1 business days for approved merchants.
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
That's it!
Just upload your recent service department processing statements and consent to the ACH processing terms below.
*
I consent to the
ACHQ 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.
Typed Name of Submitter
*
3 Months Recent Parts and Service Department Credit Card Statements
*
Drop files here or
Date Format: MM slash DD slash YYYY
Date Signed
Email
This field is for validation purposes and should be left unchanged.