Merchant Account Application Form

Merchant Account Application Form

This Merchant Account Application (the Application) is made effective as of Effective Date: , by and between Merchant Name: doing business as (Merchant), and Acquirer Name: (Acquirer).

Recitals

WHEREAS, Merchant desires to obtain a merchant card processing account to accept payment card transactions for the sale of goods and/or services described herein; and

WHEREAS, Acquirer is in the business of providing payment processing and related services and is willing to underwrite, open and maintain a merchant account for Merchant subject to the terms and conditions set forth in this Application and any subsequently executed Merchant Processing Agreement; and

WHEREAS, the parties intend that this Application constitute a representation and certification by Merchant and an offer to enter into a contractual relationship with Acquirer upon acceptance of this Application by Acquirer.

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth below, the parties agree as follows.

1. Merchant Information

2. Business Operations

Business Inception Date:

3. Processing Profile and Volumes

4. Bank Funding Information

5. Owner / Principal Information

6. Representations, Warranties and Covenants

Merchant represents and warrants that all information provided in this Application is true, complete and correct, and that Merchant will promptly notify Acquirer of any material change. Merchant covenants to comply with all applicable payment brand rules, applicable laws and regulations governing card acceptance, and to maintain records necessary to support processed transactions.

Merchant authorizes Acquirer to obtain and periodically update credit reports, verify any banking and business references, and to perform such due diligence as Acquirer deems necessary in its sole discretion. Merchant consents to the use and disclosure of Merchant information for underwriting, fraud prevention and risk management.

7. Fees, Charges, Holdback and Reserves

Merchant acknowledges that Acquirer will apply processing fees, interchange and assessments, and may establish a reserve, holdback, or chargeback reserve as determined by Acquirer in its sole discretion. Acquirer shall have the right to offset funds in Merchant’s settlement account for fees, chargebacks, fines, or other amounts due. Merchant agrees to fund any deficiency upon demand.

8. Chargebacks; Risk Controls

Merchant is responsible for responding to chargebacks and resolving disputes. Acquirer reserves the right to suspend or terminate processing, impose additional reserves, or take any other action to mitigate risk in the event of excessive chargebacks, fraud, or suspected criminal activity. Merchant shall cooperate fully in any investigation.

9. Data Security; PCI Compliance

Merchant shall comply with Payment Card Industry Data Security Standards (PCI DSS) and all applicable card brand security requirements. Merchant must not store full cardholder track data after authorization. Merchant certifies that it will implement and maintain reasonable administrative, technical and physical safeguards to protect cardholder data.

10. Notices

All notices required or permitted under this Application shall be in writing and delivered to the addresses set forth below or to such other address as either party may designate in writing. Notices delivered by email must be followed by a hard copy where required by Acquirer.

11. Termination

Either party may terminate the processing relationship upon written notice subject to any cure periods set forth in the Merchant Processing Agreement. Upon termination, Merchant shall remain responsible for obligations accrued prior to termination, including unresolved chargebacks, fees and indemnities.

12. Governing Law; Entire Agreement; Severability

This Application shall be governed by and construed in accordance with the laws of the State selected by Acquirer in its acceptance notice. This Application, together with any Merchant Processing Agreement accepted by Acquirer, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. Amendments; Waiver; Counterparts

No amendment or waiver of any provision of this Application will be effective unless in writing and signed by both parties. Failure by either party to enforce any right shall not constitute a waiver. This Application may be executed in counterparts, each of which shall be deemed an original.

14. Certifications and Authorization

By signing below, Merchant certifies that the information provided herein is accurate and complete, that Merchant is duly authorized to enter into this Application, and that Merchant authorizes Acquirer to debit or credit the bank account provided for settlement and chargebacks in accordance with the terms of the Merchant Processing Agreement to be provided upon approval. Merchant further authorizes Acquirer to obtain and share information necessary for underwriting and risk management.

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