iPayline International Payment Services

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Apply now using the iPayline Online Application.

	Rates as low as 5.00%
	No Application Processing Fees
	Transaction Management System
	Quick Approval

Thank you for choosing iPayline for your online payment processing needs. This online assessment application will provide us the information needed to quickly and effectively assess your business. Information submitted is never shared and is only used for the purpose of underwriting your application. Once submitted one of our account representatives will contact you.

If you have any inquiries you may also contact: Sales@iPayline.com or 1.888-823-8477

Please be sure to consult our restricted business types list as well as our website requirements before completing the Pre Application Form.

General Information

Application Date:

Incorporation Name:

Location of Incorporation:

Business Type (E-commerce, Pharmaceutical, etc.):

Main Web Address:

Contact Person:

Contact Telephone Number:

Customer Support Telephone Number

Time Zone:

Hours of Contact:

Contact Email Address:

Launch Date:

Additional Merchant Web Sites

Web Site Url:

Transaction Information

Are you curently processing?:

For how long have you been processing with them?:

Have you ever processed with a third party before?:

If so, which company have you processed with?:

(Expected) Number of Monthly Transactions:

(Expected) Monthly Amount Processed:

Maximum Single Transaction:

Average Charge Amount:

Total Credit Card Sales Volume for the Last 12 Months:

Expected Percentage of Credit Cards by Phone:

Expected Percentage of Credit Cards by Internet:

Total Number of Charge backs:

Total Amount of Charge backs:

Total Number of Refunds/Credits:

Total Amount of Refunds/Credits:

Other Information

Please use this space to include any additional information and to let us know how you heard about us.

In addition to the merchant checklist provided, be sure your website has the following when applying:

Website is live, all links accessible
Username and Password (if applicable)
Company clearly identified
Privacy policy and transaction security statement clearly displayed
Any legal and/or age restrictions must be clearly indicated prior to entry to website along with “click-out” links

*You will receive the complete merchant checklist when applying.

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