Online Application

Personal info of Authorized signer...

First Name*

Last Name*

Phone*

Proffessional Email*

Date Of Birth*

Social Security Number*

Personal info of Authorized signer...

Have you or your business been terminated from accepting bank cards?*

Please provide answers with transparency to improve the speed of approving your application.

If yes, please explain the reason for termination.*

Any Prior Bankruptcies ?*

Please indicate if you or your business had any prior bankruptcies

If yes add discharge date*

Ownership %*

How much do you own of the organization, Please be aware that any owner with more than 25% needs to sign the Application for approval.

Additional Owner*

Additional Owner Info

First Name*

Last Name*

Phone*

Proffessional Email*

Date Of Birth*

Social Security Number*

Tell us about your business

Legal company name*

DBA (Doing Business As) Name:*

DBA (Doing Business As) Name Others:*

Company Structure*

Date Business started*

Please enter the date your company Was officially registered and Active

Federal Tax ID*

Enter the Federal Tax ID associated with your business

Company Main Phone Number*

Please Enter your companies main contact number matching your website

Number of locations*

If your business has locations or branches please input how many locations below

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

What kind of business do you have?

Describe your business if none of the above option matches*

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

Previous Processor

If you were or currently are using a payment processor, please mention their name below

Reasons for leaving

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

Avg transaction amount*

The average transaction amount on an invoice or a ticket

Avg Monthly Card Volume*

Provide expected or current total monthly Card transaction volume.

Highest ticket amount*

Payment Methods you want to accept*

What Payment options do you want to provide your clients

Payment Type

Business Type
Processing Info
Days to Delivery

Payment Type required*

Select how you would like to collect payments from your customers, Auxpay is for Card not present i.e online payment gateway, txt-2pay, phone payments. Dejavoo Terminal is for in store & in person transactions.

AuxPAY Gateway

In Person Payment Terminal

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

$0.00

/Per Month

AuxRev

Processing fee:

3% + 0.29 c per transaction
Ability to Pass the fee to customers as a tech fee.
Offer a cash discount programme (no fee for cash payments).

AuxRev is Your pricing option*

Accept Program

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

$29

/Per Month

AuxFlex

Per Transaction Fee - Qrev
For Transactions processes via Qrev

Charged to you: $0
Charged to cardholder: 3.0% +0.29 c

Per Transaction Fee - Flat Rate

Charged to you: 2.8% +15c

Additional fees

Charge back, ach reject, fees 35 USD with support
charge back fees 29 USD without support Insufficient funds decline 2.99 USD fee
Let the customer choose payment types : cash, card, ACH.

AuxFlex is Your pricing option*

Accept Program

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

AMP 8200

Compatible with Qrev and Flat Rate Program Only

AMP 8200 do you want to accept?*

Accept Program

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

DEJAVOO QD2

Compatible with FlexPay Program Only

DEJAVOO QD2 do you want to accept?*

Accept Program

Tell Us About Your Business

Business Type
Processing Info
Days to Delivery

Product type*

Describe your product/service briefly

Website related*

Please select the answers that are relevant to your

How often do you bill your customers*

Please select the answers that are relevant to your

How many days after purchase does the consumer receive goods or services?*

0-3 days

4-7 days

8 or more

Do you accept payments on a website?*

Yes

Great! Let us know where*

Where is your business located?

DBA
Legal Info

Doing Business As - This is what your customer sees.

Street Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Where is your business located?

DBA
Legal Info

Leagal Info Address

Street Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Tax ID Number

Tax

Where do we send your deposits?

Bank Routing (ABA)*

Bank Account (DDA)*

Bank Name*

Upload Check

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Additional services we think you will love

Additional Aux services*

Choose which additional service you need to boost your ROI

Additional services we think you will love

Office Number*

Upload your tel number latest bill

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Card Not Present Information

If internet, please select your type of business:*

Selling Hard Goods

Digital Products

Services

Other

How will the product be advertised or Promoted?*

How often will you bill your customer?*

Monthly

Yearly

One Time

List the name(s) and address(es) of the vendor(s) from which the supplies are purchased:*

Who performs product/service fulfillment? If from vendor, please provide vendor name, and phone number in fulfillment*

Do you use any third party to store, process or transmit cardholder data?*

Sign Your Application

Please review documents below to complete online application*

By checking you confirm that you have read, understand and agree to the Program Guidelines.

I the signer, certify that I am authorized to open the account, acknowledge Certificate of Beneficial Ownership and certify o the best of my knowledge that the information provided is complete and correct.

Signature*

Your Name
Your Name
Your Name

By submitting this application, I agree to reviewing all terms and conditions set above the Merchant Processing Agreement the program Guideline and to do business electronically with AuxPay