Merchant application

Apply for processing

This is the Payzli Connect merchant application. Submit sends it to Payzli for boarding.

Staging demo — the form is pre-filled with sandbox test data. Hit submit to send it to Payzli Connect demo.

Step 1

See your savings

Open Quick Quote for an instant estimate, or upload one month of card processing statements for a comparison.

Or upload a statement

Industry

Estimated Rate

Click to upload or drag & drop

PDF, JPG, or PNG — one month of processing statements

I agree that my data is processed securely and never stored or shared

Step 2

Payzli merchant application

This is the Payzli Connect merchant application. Submit sends it to Payzli for boarding (live Payzli Connect).

Contact information

First name *

Last name *

Email *

Phone number *

Business information

Failure to provide accurate information may result in a withholding of merchant funding per IRS regulations.

Business legal name *

DBA name

Tax filing name *

Tax filing method *

EIN SSN

Tax ID (EIN / SSN) *

Type of ownership *

Stock exchange (public corporations only)

NYSE or NASDAQ Other / N/A

Stock ticker symbol

Industry (MCC)

Business description

Industry options — Quasi cash

Business start date *

Website

Business phone *

Card processing volume

Payzli requires this to underwrite the merchant account. Use expected annual card sales, not total practice revenue.

Annual card volume (USD) *

Example: 250000 for $250,000 a year in card payments.

Average sale amount (USD) *

Typical card charge — for example 250.

In-office (card present) %

Online / keyed-in %

Business address

Street address 1 *

Street address 2

City *

State *

ZIP *

Country

Business legal mailing address

Same as business address

Street address 1

Street address 2

City

State

ZIP

Country

Business owner information

Provide information for each individual who owns 25% or more of the business, or who has significant responsibility to control, manage, or direct the business.

First name *

Last name *

Street address 1

Title *

% ownership *

Personal guarantee

Yes

SSN

Date of birth *

Mobile phone

Street address 2

City

State

ZIP

Country

Additional business owner (optional)

First name

Last name

Street address 1

% ownership

SSN

Date of birth

Mobile phone

Street address 2

City

State

ZIP

Country

Confirmation & agreement

Payzli Connect boarding. You are applying for merchant processing with Payzli. Underwriting, pricing, bank linking, and e-sign are completed in Payzli Connect after this application is received.

Accuracy. You certify the information is true and authorize Payzli and its partners to run credit and KYC checks needed to board the merchant account.

Processor: Payzli · Support 813-565-9999 · connect.payzli.com

Client initials *

Print business legal name *

Personal guarantee signature *

Personal guarantee date *

Agreement signature *

Agreement date *

Title *

Print name of signer *

Notes for your representative (optional)

I certify that the information is correct and I agree to submit this application to Payzli Connect for merchant boarding.

Cancel

Apply for processing

See your savings

Statement report

Key findings

Fee breakdown

Payzli merchant application