High Risk Merchant Account | Global Merchant Account Group

Just a few questions. In order to better understand your request and to expedite your application, please fill out our basic information form and we will get back to you within 24 hours. You need only answer the questions that pertain to your specific needs.
Type of business:
Product or Service:
Are you a brand new startup?		Yes No
How long have you been in business?
Are you currently processing?		Yes No

If you ARE NOT currently processing:
Estimate your average sales ticket:
Estimate your monthly sales volume:

If you ARE currently processing:
	What is your current discount rate?
	Who is your current processor?
	What is your average sales ticket?
	What is your monthly sales volume?

How are you currently getting business?
	The traditional way - retail, over the counter:	Yes No
	Percentage of sales:

	Mail orders / phone orders (MOTO) / telemarketing:	Yes No
	Percentage of sales:

	Online/Internet:	Yes No
	Percentage of sales:

*Your Name:

Your Company Name:

Doing Business As (DBA):

State/Province:

Country:

Phone:

Fax:

*E-mail:

Web Site Address:

Further information or comments:

*Required Fields

(866) 287-9357

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