Merchant Source POS

Figure out your savings below!

Monthly Fee Comparison

FEES	MERCHANT SOURCE POS	OTHERS
INTCH FEES	WAIVED	2.00%-4.00%
TRANS FEES	WAIVED	$0.05-$0.25
BATCH FEES	WAIVED	$0.05-$1.00
STATEMENT	WAIVED	$5.00-$19.00
PCI FEES	WAIVED (With Annual PCI Test)	$19.99-$50.00
MONTHLY MIN.	WAIVED	$25.00-$50.00
ANNUAL FEES	WAIVED	$99.00-$199.00
CONTRACT	NO CONTRACT	1 TO 4 YEARS
JUNK FEES	WAIVED	$1.99-$199.00

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Date:

BUSINESS INFORMATION

Corporate Business Name:

Doing Business As:

Business Address:

Business City

Business State:

Business Zip Code:

Business Phone:

Business Fax:

Federal Tax ID:

Email:

Website:

Type Of Business

Business Start Date:

Products or Services Sold

Type Of Ownership

Send Business Certificate (REQ.):

Upload File

OWNER INFORMATION

Owners Name

Title

Percentage of Ownership

Date of Birth:

Social Security Number:

Drivers License Number:

Drivers License-I.D. Exp. Date:

Drivers License State:

Are you a US Citizen?

If not a US citizen, attach your tax id

Upload File

Send Drivers License or I.D. (REQ.)

Upload File

HOME INFORMATION

Home Address

Home City

Home State

Home Zip Code

Cell Phone Number:

BANKING INFORMATION

Name of your Bank:

Routing Number:

Account Number:

Send Voided Check (REQ.):

Upload File

BUSINESS PROCESSING

Average Ticket/Sale:

Largest Ticket/Sale:

Avg. Monthly Volume

Avg. Monthly Fees:

Type of program your in:

Are you currently processing?

Current Processor, if none type NA:

Early Termination Fee?

Send Recent Statement

Upload File

TERMINAL INFORMATION

Current Terminal Type:

Does Your Business Accept EBT?

If EBT, what's your EBT #?

Does Your Business Accepts Tips?

Add a tax line to your terminal:

If Yes to taxline, enter tax rate:

LEASE INFORMATION

Are you in a lease?

If in a LEASE, how long?

If in a LEASE, how much?

UNDERWRITING

How do you process cards?

When do you get your deposits?

Is your business involved in:

CASH ADVANCE INFORMATION

Do you have a cash advance?

If you have a cash advance:

Cash Advance Received:

Interested in a cash advance?

Send Cash Advance Agreement:

Upload File

ADDITIONAL INFORMATION

Notes, if non, type NA:

OPT-IN

Opt-In

Please note that by clicking this button, you understand that you are applying for a merchant account with Valeska Capital. Applying for a merchant account may be subject to a personal & business credit check. By applying for a merchant account with us, you understand that you may be denied due to poor credit or a poor merchant history. If you are denied a merchant account with us, a mailing will be sent with details of your denial. Additional documents may be required. An application will be generated based on the information on this form & emailed to you via docusign to sign. When you get the application, please sign & click send. If you are approved, a sales rep will be assigned & will call you to go over details of your application. Should you have any questions, please feel free to call us @ 888-226-2612