Merchant Account Online Application

Please complete the application below and a SIRQA representative will contact you shortly. If you have any questions our representatives are standing by at 1-800-811-3795

Personal information or e-mail addresses collected on our online application form are confidential and will be used only for the purpose of processing your application.

Company Information
Business Name
Physical Business Address
City
State
Zip Code
Contact Telephone Number
Office Telephone Number
Fax Number
Please Tell Us About Your Business
Type of Business
Type of Merchant
Website Address
Email Address
Credit Card Processing Needs
Average Ticket Size
Monthly Credit Card Volume
Equipment / Service Needs - skip if you have no equipment needs
Terminals & Printers in One
Terminals
Pin Pads & Check Readers
Wireless/Phone Service
Software
Internet / Web Site
Ownership Information
Owner Name
Business Entity
Owner Home Address
City
State
Zip Code
Home Phone
Other
How did you hear about us?
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Special Instructions
 

Final approval is subject to receipt by us of an executed Merchant Processing Application and Agreement.

 
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Sirqa, LLC is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, CA