New Merchant Application

Business Information

Legal Name DBA (Business Name) Tax ID / EIN Number Location Address Legal Address City State Zip Code Contact Phone Number Contact Email Contact First Name Contact Last Name Anticipated Annual Volume Product or Service Sold Bank Name Bank Routing Number Bank Account Number Website URL

Owner / Officer / Director Info

First Name Last Name Home Address Phone Number Date of Birth Social Security Number

Identity Verification

Driver's License Military ID State ID Passport

Accepted file types: .jpg, .jpg, .png, .pdf, .bmp

Max file size: 2.5MB

Address Verification (Must match address on application)

Voided check Utility Bill Bank statement

Accepted file types: .jpg, .jpg, .png, .pdf, .bmp

Max file size: 2.5MB

I agree to sign up with Cornerstone Payment Systems and to the Terms and Conditions.

Questions? Contact Cornerstone at info@cornerstone.cc or (888) 506-0208 (Phone available Mon-Friday 6:00am–5:00pm Pacific Time)

Note: Approval times may be delayed if the information provided is incorrect