Tell us about yourself

Owner Name:

Email Address:

Mobile:

Owner Address:

Date of Birth:

Social Security Number:

Please enter the last four digits of your Social Security Number, for security puposes.

Complete information on all owners with 25% or greater equity ownership in the company listed below must be disclosed on your application per U.S. Treasury Customer Due Diligence Requirements.

Owner 2

Remove

Name:

Email Address:

Mobile:

Owner Address:

Date of Birth:

Identification:

In lieu of a Social Security Number, Foreign Persons must provide a Passport Number.

Job Title:

Owner has significant responsibility to control, manage or direct the company

Ownership Percentage:

The percent ownership stake that this person has in the company listed below.

Complete information on all owners with 25% or greater equity ownership in the company listed below must be disclosed on your application per U.S. Treasury Customer Due Diligence Requirements.

Owner 3

Remove

Name:

Email Address:

Mobile:

Owner Address:

Date of Birth:

Identification:

In lieu of a Social Security Number, Foreign Persons must provide a Passport Number.

Job Title:

Owner has significant responsibility to control, manage or direct the company

Ownership Percentage:

The percent ownership stake that this person has in the company listed below.

Complete information on all owners with 25% or greater equity ownership in the company listed below must be disclosed on your application per U.S. Treasury Customer Due Diligence Requirements.

Owner 4

Remove

Name:

Email Address:

Mobile:

Owner Address:

Date of Birth:

Identification:

In lieu of a Social Security Number, Foreign Persons must provide a Passport Number.

Job Title:

Owner has significant responsibility to control, manage or direct the company

Ownership Percentage:

The percent ownership stake that this person has in the company listed below.

By checking each box below and clicking I AGREE, I confirm that I understand and have read each of the linked documents, and the business indicated above agrees to be bound by the terms contained therein:

By checking "I agree" and clicking SUBMIT:

I represent and warrant that I am the individual listed on the merchant application as the Applicant;
I authorize Authorize.net LLC and/or its subcontractors and merchant services providers to periodically obtain consumer reports about me and share such reports with their partners and affiliates in order to evaluate my request for a merchant account as well as my continued eligibility for a merchant account; and
I confirm that I understand and have read the document linked below, and the business indicated above agrees to be bound by the terms contained therein:

Authorize.net Gateway Service Agreement and Fees

Authorize.net eCheck Service Agreement

Global Direct Card Services Agreement

Merchant Services Agreement

Please click the check box to indicate that you have read and understand the Authorize.net Payment Gateway Merchant Services Agreement before you click I Agree.

Please click the check boxes to indicate that you have read and understand the Authorize.net Payment Gateway Merchant Services Agreement and eCheck Services Agreement before you click I Agree.

Please click the check boxes to indicate that you have read and understand the Authorize.net Payment Gateway Merchant Services Agreement and Merchant Account Services Agreement before you click I Agree.

Authorize.net Fees

The one-time fee charged to establish a payment gateway account.

Setup (Non-Refundable)

$0.00

The monthly fee charged for a payment gateway account.

Monthly Gateway

$10.00

The fee assessed per batch of settled credit card transactions.

Batch

$0.10

The fee charged by the payment gateway for each credit card transaction processed for the account. The credit card transaction types that the per-transaction fee is charged for include: authorizations, capture, refunds, declines or other related transactions, completed or submitted within the payment gateway.

Credit Card Per Transaction

$0.10

Additional Services

The monthly fee for the ability to process automated recurring billing transactions.

Automated Recurring Billing ^TM

Free

The monthly fee for access to Authorize.net's fraud-fighting tools.

Advanced Fraud Detection Suite ^TM

Free

The monthly fee for the ability to create and manage customer subscriptions.

Customer Information Manager

Free

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Merchant application

Help us understand your business by answering the questions below.

Merchant Services Agreement

Create your Authorize.net Account

Authorize.net Fees

Additional Services


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