Authorized.net
Application
All fields are required!  

Business Name
Address

City
State/Province
Zip Code
Phone
Fax
Admin E-mail Address
Business Type
Products Sold
Tax ID
Age of Business

Owner Info
First Name
Last Name
Social Security #
Home Address
City
State/Province
Zip Code
Phone





Cards I now accept through my bank:
Visa
MasterCard
American Express
Discover
JCB
EnRoute
Diners Club/Carte Blanche
NOTE: It is the applicants sole responsibility to determine that their current merchant account is Authorize.Net compatible. If your bank cannot readily answer this, or cannot supply the variables requested below, it is probably not. Remember, it's not a problem! If you determine that you DO need an Authorize.Net-compatible merchant account, just click here.
Processing Network           
Bank Information
Name on Account
Account Type
Account Owner Type
ABA Routing Number
Account Number

Bank Name
Bank City
Bank State
Bank Zip
checking     savings
business    personal


Basic Fee is $29.00

Options

Click the info Info button to find out more about each service
1 Fraud Detection Suite Info
Yes     No
One-time setup: $79
Price/month (Tier Based):
0 - 100 Transactions: $12.50
101 - 1000 Transactions: $30.00
1001 or more Transactions: $99.00
2 Automated Recurring Billing Info
Yes     No
One-time setup: $40 setup
Price/month: $20
3 eCheck Net Info
Yes     No
One-time setup: $9.95
Price/month: $10
Transaction Fee: .25
Discount Rate 1.95%
4 Cardholder Authentication Info
Yes     No
Setup Fee: $0.00
Monthly Fee: $20.00
Per Transaction Fee: $0.06

Payment Information
for one time setup, monthly fees billed to checking account
Card Number
Exp Date
Security Code
 -  -  -
/
Billing Address

Billing Zip

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