Apply Now With EzPay AmericaMerchant ApplicationBusiness InformationBusiness Name*Business Designation* Corporation LLC Sole Proprietor PLLC Non-Profit Government / MunicipalityBusiness Physical Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone Number*Email* Business Website Owner InformationOwner (Must Own 51% Or More Of Business)* First Last If there is more than one owner, we will require information for all business owners. Including the percentage of the business owned, Residence information and copies of all owner's driver's licenses.Cell Phone*Personal Email* Date To Contact You By Telephone* Date Format: MM slash DD slash YYYY Best Time To Contact You* : HH MM AMPM EzPay America understands that as a business owner your time is important. Rather than have an agent show up at your business and interrupt your workday. We prefer to initially speak to you over the telephone. We understand that you are busy and respect your privacy.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.