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Business Information





If different from legal name







If your account will be enabled with Texting options, this will be the area code sent with number to message recipient.
BUSINESS OWNER 1 (Or Authorized Signer) INFORMATION




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

BUSINESS OWNER 2 INFORMATION (If ownership is 25% or greater)




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

BUSINESS OWNER 3 INFORMATION (If ownership is 25% or greater)




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

BUSINESS OWNER 4 INFORMATION (If ownership is 25% or greater)




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

Other Information


LLC, Inc., Sole Proprietor, etc.




9 Digit number on your checks


Exhibit A - Pricing Schedule
Software & Merchant Services:  
  • 3.20% Flat Rate Fee on Transaction Volume
  • $0.15 Per Transaction
  • $30.00 Monthly Minimum Fee (only charged if monthly processing fees are less than $30.00)
Card Readers: 
  • $130.00 IDTech M130 Card Reader w Keypad for Manual Entry
* NOTE: Device orders are non-refundable. 

One Time Fees: 
  • $15.00 ACH Return Fee Per Return
  • $35.00 Chargeback and Retrieval Fee Per Instance
  • $25.00 PCI Non Compliance Fee Per Instance

SwervePay is a Level 1 PCI Certified provider and is recognized as such on Visa's website (https://www.visa.com/splisting/). SwervePay is also a Registered Payment Facilitator and recognized as such on MasterCard's website (https://www.mastercard.us/en-us/merchant/start-accepting/payment-facilitators.html).

PCI Logo
Device Ordering and Fulfillment



Customer Service Contact Information

Owner Home Phone Number

Signer Information






For the attachments below, please use .pdf, .png, or .jpg files.



If there are different bank accounts per location, a voided check or bank letter is needed for each account verifying the account being underwritten is the merchant of record. This confirms the deposit and fee accounts.

Two years of this information is requested along with financials up to date. These can include Balance Sheet/Income Statement or Business Tax Returns.

Please provide the most recent three months of statements.

Please provide the most recent three months of statements.

These documents assist with verifying the business identity.

These documents assist with verifying the business identity.

Please provide the merchant application signatory's identification by supplying either a copy of valid state-issued ID or the Passport of the signer(s).
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