Get Started – Impact Processing

Ready to Impact?

Fill out our quick and easy pre-qualification form.

Business Legal Name:

DBA (Business Name):

DBA (Business Address):

City:

State:

Country:

Zip:

Phone:

Fax:

Web Address (if any):

Business Email:

Brief Description of Services and/or Goods Sold:

Business Type:

Corporation Limited Liability Sole Proprietorship Partnership

Number of Locations:

State Incorporated:

Date Incorporated:

Federal Tax ID#:

Business Start Date:

Officer/Owner Name:

Title/Position:

Officer/Owner Home Address:

City:

Zip:

Phone:

Date of Birth (DOB):

Driver's License/ID :

State:

Social Security # (U.S. only):

Contact Email:

Monthly Processing Volume (in USD):

Average Ticket Amount (in USD):

Highest Ticket Amount (in USD):