Connected.co Merchant Application

If you are not using an agent, please leave blank.
Who are you working with at Connected.co?
Legal Business Information
Business name used on your tax forms
Federal Tax ID or Social Security Number
Please no hyphens, spaces or dashes
Does Business As (DBA) Information
Primary Contact Information
Business Contact Information
http://
If you have multiple URLs for one merchant account.
http://
If you have multiple URLs for one merchant account.
http://
If you have multiple URLs for one merchant account.
http://
Technical Contact Information
Funds Settlement Bank Information
Goods & Services
All percentage provided by Card Present Swiped/Not Swiped, Internet, Mail Order & Phone must = 100%
All percentage provided by Card Present Swiped/Not Swiped, Internet, Mail Order & Phone must = 100%
All percentage provided by Card Present Swiped/Not Swiped, Internet, Mail Order & Phone must = 100%
All percentage provided by Card Present Swiped/Not Swiped, Internet, Mail Order & Phone must = 100%
All percentage provided by Card Present Swiped/Not Swiped, Internet, Mail Order & Phone must = 100%
Please put the name of the vendor here. If you do not purchase your goods from a vendor, please put "No"
If you answered "yes" above, what percentage of the sales is required?
Marketing Methods
Product Fullfillment
Processing Summary & History
Pct Monthly recurring, annual recurring, one time and other frequency must = 100%.
Pct Monthly recurring, annual recurring, one time and other frequency must = 100%.
Pct Monthly recurring, annual recurring, one time and other frequency must = 100%.
Pct Monthly recurring, annual recurring, one time and other frequency must = 100%.
PCI-DDS Compliance
Principal #1 Information
Principal #2 Information
If there isn't a second principal, skip to the BUSINESS LOCATION INFORMATION section
Business Location Information
**Reminder** If you are working with a referral agent, please email them your supporting documents.