Merchant Name (DBA)
Business Name*
Contact Name*
Contact Email*
Phone Number*
(No P.O. Boxes)
City, State, Zip Code*
Website* http:// 

Corporate/Legal Name
Business Start Date*
Business Legal Name*
Business Address*
(No P.O. Boxes)
City, State, Zip Code*
Years at address*
Website http:// 
    Company Does Not Have a Website
Business Phone Number*
Business Model Details Yes    No
 Visa  MasterCard  Discover  American Express
Monthly Sales*
Est. Highest Ticket*
Average Ticket*

Settlement Details
Banking Information*
Bank Country*
Routing Number
(US accounts)
Bank Account
Principals(s) / Owner(s)

Principals(s) / Owner(s)

City, State, Zip Code*
Phone Number*
Title* % of Ownership*

  There is more than one Principal/Owner
Submit Application

You are almost done. Please take a moment to download the Nexcharge Merchant Services Agreement by clicking the link below. It contains important information regarding your processing account with Nexcharge.

Nexcharge Merchant Services Agreement

We also require your authorization to process this application. By signing below (1) agrees that they have received a copy of the Merchant Services Agreement, (2) agrees to all such terms and conditions, (3) agrees that all information provided on this application is true, correct and complete, (4) agrees that they have the legal power and authority to execute this agreement, (5) authorizes Nexcharge and our Acquiring banks to investigate, either through its own agents or through credit bureaus, all information provided on this agreement and on the individual(s) signing this agreement, (6) agrees that Nexcharge and our Acquiring banks may give information to others, including creditors and credit reporting agencies concerning the Nexcharge and our Acquiring banks experience with merchant and that Nexcharge and our Acquiring Bank may request additional information as needed.

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Draw your signature

Thank you for choosing Nexcharge.  We will be processing your information immediately.  Expect to hear from your Nexcharge representative in the next few days to discuss account activation.  If you require assistance before that please email

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