Start the Process

Please fill out the form below to begin your application.

Business Information

Legal Business Name

Website URL

DBA (if applicable)

Industry / Vertical

Contact First Name

Contact Last Name

Contact Title

Contact Cell Phone

Business Address

City

State

ZIP

Business Phone

Business Email

Federal Tax ID (EIN)

State of Incorporation

Date Established

Business Type

Ownership

Owner 1 Full Name

Owner 1 Title

Owner 1 Ownership %

Owner 1 Phone

Owner 1 Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Processing & Volume

Estimated Monthly Card Volume (USD)

Average Ticket Size (USD)

Highest Single Transaction (USD)

Card Not Present %

ACH Invoice %

Current Processor & Reason for Switching

Compliance & Legal

CRM Provider

Do you use an affiliate network?

Yes

Are you or any owner on MATCH?

Yes

If yes , please explain

Are you or any owner involved in, or have you been involved in, any state or federal legal action?

Yes

Please explain

Have you or any owner ever filed bankruptcy?

Yes

Please explain (include discharge date)

Communications Consent: By submitting this application, you expressly consent to receive calls, text messages, and emails from AltirasPay regarding your application, account, payment processing services, and related updates using the contact information you provide, including via automated technology where permitted by law. Consent is not a condition of obtaining services. Message frequency may vary. Message and data rates may apply. You may opt out of text messages at any time by replying STOP

By submitting this form you agree to our Terms and Conditions ("Terms") that govern access to and use of the AltirasPay website, intake forms, merchant pre-application materials, consulting services, underwriting-support services, referral services, placement-support services, compliance-support services, document-packaging services, AI-assisted intake and file-preparation services, AI and agentic technology services offered to businesses, communications, technology tools, and all related services offered by AltirasPay, LLC ("AltirasPay," "we," "us," or "our"). By accessing our website, submitting an inquiry, completing a pre-application, providing documents, engaging with our team, using our services or technology tools, authorizing us to contact banks, acquirers, processors, gateways, payment facilitators, vendors, or other financial-technology providers, or otherwise working with AltirasPay, you agree to these Terms. If you are acting on behalf of a business, merchant, owner, officer, director, manager, beneficial owner, principal, contractor, affiliate, or other organization, you represent and warrant that you have authority to bind that person or entity to these Terms. If you do not agree to these Terms, do not use the website or the services.