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We appreciate your interest in jetCHEX. Please fill out the application below and one of our corresponding representatives will contact you immediately to complete the application process. If you have any questions or concerns, please call 866-587-3777. Information provided is private and confidential and will not be used or sold for any reason other than to apply for payment processing through jetCHEX. A completed application will be emailed directly to you for signature requirements and instructions.
 
If you are applying for just ATMVerify or Direct Recovery with out payment processing, please fill out contact information, request the product down below, and an application will be emailed immediately. Call 866-587-3777 with any questions.

 
Name:  
Title:  
Company Business Name:  
or DBA:  
Business Phone:  
Business Fax:  
Customer Service #:  
*Name that will appear on your customers Bank Statement
 
Street Address:  
 
City:  State:  Zip: 
 
Name of primary contact person:  
Phone #:  
Email Address:  
 
Business Type:
Sole Proprietor Partership Limitied Liability Co. Corporation
NonProfit Sub Chapter Publicly Held  
Other:  
 
Year Established:  
 
Ownership : (principal, partner, owner, manager name, must have at least 51% ownership represented)
     
Name:  
Title:  
% Equity Ownership:  
     
Ownership:  
Name:  
Title:  
% Equity Ownership:  
     
Types of Goods Sold/Services (please explain):  
     
URL:  
% of goods sold single payments:  
% sold recurring:  
Projected Avg. Debit Ticket Size:  
Projected Avg. Credit Ticket Size:  
Projected Monthly Debit Transactions (# of):  

Projected Monthly Credit Transactions (# of):

  
Projected Monthly Debit Dollar Amount:  
Projected Monthly Credit Dollar Amount:  
Projected Maximum Single Debit Amount:  
Projected Maximum Single Credit Amount:  
 
Products and Services Requested:
 
ACH Processing

Donation Software Online

Shopping Cart Software Online Payment Application
Check Reader/Imager DirectBilling
ATMVerify PaymentsGateway
DirectRecovery Integration
SoftTerminal Other:
VirtualTerminal  
 
Any other comments to help us serve you better?
 
              
 
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