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sales@edebitdirect.com
888-616-2535

Menu

Home
Services
About
Industries
ACH
Resellers

Application

eDebit Direct: Your Choice for Payment Solutions

At eDebit, we provide tailored payment options across three versatile platforms to meet your unique business needs.

Application

Please fill in your company information and we can typically have you up and running in as little as 24 hours!

Thanks for your interest in eDebit Direct.

“*” Indicates required fields

* Please note that your information is saved as you enter it.

Application

"*" indicates required fields

Facebook

This field is for validation purposes and should be left unchanged.

Business Info

Legal Business Name*

DBA Name (if applicable)

Years in Business*

Referred by (if applicable)

Business Physical Address*

Street Address Address Line 2 City State ZIP Code

Time at this location*

Full Name of Business Contact Person*

Business Contact Title*

Business Email*

Business Phone Number*

Business Website*

Tax ID*

Corp. Type*

Corp. State*

Business Bank*

Routing Number*

Ownership Info

Principal Owner Name*

% of Ownership*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Any Additional Owners?*

Yes

No

Principal Owner Name*

% of Ownership*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Any Additional Owners?*

Yes

No

Principal Owner Name*

% of Ownership*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Any Additional Owners?*

Yes

No

Principal Owner Name*

% of Ownership*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Processing Info

How many transactions (debits) will you process per month?*

What is the average dollar amount per transaction?*

Highest amount you receive on any single transaction*

Estimated monthly dollar amount of transactions?*

Do you have Recurring Payments?*

Yes

No

What % of Monthly Volume is Recurring?*

What is your refund policy?*

What is the average dollar amount per refund?*

What is your estimated monthly dollars refunded?*

Describe how you market your goods or services*

Do you require website integration?*

Yes

No

What type of website integration do you require?*

WooCommerce

Shopify

Magento

Debt Pay Pro

Rest API (Used for CRMs, Websites, etc...)

Other

Select all types of goods or services provided by your business.

Document Upload

To expedite your account approval please upload all 4 of the following documents. They will be placed in a secure/encrypted DropBox.

Copy of Owners Driver’s License or Passport*

Drop files here or

Max. file size: 3 GB.

Bank Document showing business name*

Drop files here or

Max. file size: 3 GB.

Articles of Incorporation

Drop files here or

Max. file size: 3 GB.

Copy of EIN, SS4 or last years tax filling

Drop files here or

Max. file size: 3 GB.

*Additional documents may be required

Enter an email address where a copy of the form will be sent.*

Prove you're not a robot. What is 11+6?

*You will be redirected to the terms and conditions signing page after pressing submit. Please read the entire document before signing.

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15+ years supporting ACH and eCheck payment processing

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Contact Info

6528 Greenleaf Ave #106 Whittier, CA 90601
888-616-2535
support@edebitdirect.com
sales@edebitdirect.com

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