×For your security, you will have up to four hours to complete this form. Please review the form and be sure to have all the information requested before you begin. Also, you may need to upload several documents, depending on your type of business and your state requirements. If the form senses no activity after four hours, you will have the option to extend the time by clicking a button when prompted. If you do not respond, it will timeout and any data you entered will not be saved.

Merchant Application

CanPay Merchant Application Information Submission Form:

Your Information
 Yes  No
DBA Location Information
 Retail   WEB   Both Retail and WEB
 Medical   Recreational/Retail   Both   None
 Yes  No
 To DBA   To Legal   Other
Location Reporting Information
Legal Entity Information
 DBA Address / Authorized Signer  Legal Address / Authorized Signer  Other Legal Representative or Different Authorized Signer (such as a registered agent, corporate counsel, or other)
Authorized Signer Information
Bank Deposit Information
  I want to use a separate bank account for fees charged by CanPay
 Yes  No