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uMerchants Payments Application

uMerchants Payments Application

This is the uMerchants payments processing application form. Once completed, you will receive a PDF version of the form and one will be sent to our approvals team to begin the onboarding process.

Business Information
Operating Business Name *

(Doing Business As)

Legal Business Name *
Business Physical Address *

(no P.O. Boxes)

Business Mailing Address

(if different from Physical)

Business Phone Number *
Customer Service Phone Number

(if different from Business)

Business Fax Number
Website Address *
Business Email Address *
Products and/or Services Sold *

Please fill out the following information: Primary activities of business , Services Offered, Types of Products Sold, Current Target Customers (B2B, B2C, Enterprise, etc.), Future Target Customers, Wholesale/Retail, and other information that may be important.

Date Business was Established *
Ownership Since *
Ownership Type *
Primary Contact
First Name *
Last Name *
Phone Number *
Fax Number
Email Address *
Expected Processing
How will you process customer payments?

The three sections must total up to 100%. If 0, then put 0 value in field.

Face-to-Face *

Please fill out a percentage value (%) between 0 and 100. Make sure these 3 answers add up to 100%

Phone / Fax / Email / Mail *

Please fill out a percentage value (%) between 0 and 100. Make sure these 3 answers add up to 100%

Website *

Please fill out a percentage value (%) between 0 and 100. Make sure these 3 answers add up to 100%

Financial Institution
Name of Deposit Financial Institution *

What is the name of the financial institution that you will have your funds deposited to?

Address of Home Branch of Financial Institution *

What is the address of the financial institution that you will have your funds deposited to? This is the address of the bank branch on your cheques. (See cheque sample below)

Branch Transit Number *

Look on your check for your branch transit number (eg. 03029 etc.) and input it here. (See cheque sample below)

Institution Number *

Look on your check for your institution number (eg. 002 etc.) and input it here. (See cheque sample below)

Account Number *

Look on your check for your account number (eg. 0903 23410 etc.) and input it here. (See cheque sample below)

Cheque Sample
Explain Funding Policy

Explain if you require next day funding/settlement or if you only want standard batch settlement terms (2-3 business days).

Expected Volume
Transaction Information

Expected annual transaction volume (in dollars). If 0, then put 0 value in field.

Visa *

Dollar Amount

Mastercard *

Dollar Amount

Estimated average transaction amount *

Dollar Amount

Estimated highest transaction amount *

Dollar Amount

Do you use payment processing services already? If so, please list your service provider name.

This can be existing retail payments processing or online.

How much transaction value in payments do you process monthly on average with your existing provider?
Credit Card Information
Please enter your credit card number for payments of uMerchants fees. *
What type of card is this?

There may be extra charges for other cards such as American Express (fill out "other" field)

When is the exipry date of your card?

Enter as MM/YY

What is the CVC of this card?

The CVC code can be found on the back of your card

Is this a Business Credit Card or your Personal Credit Card?
What is the name on the credit card?
Does the address information match what you filled out in this form? If not, please fill out address information below.
Ownership Information
Authorized Signee or Owner Information

The next page is available for a 2nd owner to fill out their information as well. If more than 2 owners, please contact us for a more comprehensive form.

First Name and Last Name *
Title

(Director, Owner, Co-Owner, etc.)

Owner's Home Address *
Bank customer since *

(Personal or Business)

Rent or Own *

Do you rent or own your primary residernce?

Years at Current Address *

How many years have you lived at your current primary residence.

Previous address

(If less than 2 years at current address)

Date of Birth *
Social Insurance Number

(optional)

Home Phone

Home Phone or Direct Mobile Contact Number

Personal Email Address

Additional: Authorized Signee/Owner

Additional: Authorized Signee or Owner Information

Complete for each partner, if applicable. (This page is not required for single owner). If additional owners to be listed are required, please contact us for more information.

First Name and Last Name (2nd)
Title (2nd)

(Director, Owner, Co-Owner, etc.)

Owner's Home Address (2nd)
Bank customer since (2nd)

(Personal or Business)

Rent or Own (2nd)
Years at Current Address (2nd)
Previous address (2nd)

(If less than 2 years at current address)

Date of Birth (2nd)
Social Insurance Number (2nd)

(optional)

Home Phone (2nd)

Home Phone or Direct Mobile Contact Number

Personal Email Address (2nd)
Additional requirements that may be requested

* 2 years audited financials
* Compiled financials (balance sheet and income statement)
* Bank Reference Form
* License to operate
* Other information