Total Epay
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Registration as Business

Total ePay is required by law to “know” its CUSTOMER. The following information is required in order to open an account at Total ePay. After submitting the registration by clicking the button at the bottom, you will be contacted by a Total ePay representative to determine your needs.

All required fields in bold must be filled in. "No special characters allowed".
Company Information:
Company Legal Name:
Company EIN / Federal
DBA Name:
[Please note the 1st 10 characters of the name will appear in your monthly statement]
Contact First Name Contact Last Name
Legal Address Line 1:
Legal Address Line 2:
City Zip
State Phone: () -
Fax: ( ) - Email:
Website:
Company Information:
Type Of Ownership:
Year Incorporated: Place Incorporated:
Goods Or Services Sold:
Years In Business:
Years Owned:
Bank Information:
Depository Bank Name:
Deposit Account Number: Account Name:
ABA Transit Routing Number: Account Type:
Bank Contact Name(Required for Bank Verification)
Bank Address Line 1:
Bank Address Line 2:
City State
Zip Phone: () -
Fax:
Other Information:
Min Transaction Amount:
Max Transaction Amount:
Transaction Volume Information:
How many transactions do you expect
Daily:         Weekly:         Monthly:    
If you have peak days ( Pls specify )
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Avg Transaction Amount:
Percentage of monthly returned transactions:
Alert me if the transaction amount is higher than average:
Company Owner Information
Name SSN:
Residence Address Line 1
Residence Address Line 2
DOB(mm/dd/yyyy): City
State Zip
Driver's License # State of Issue
Expiration Date (mm/dd/yyyy)
Are there more than one owner in the Business
Company Officers Information
                    Check, if same as Company Owner Information
Name: SSN:
Residence Address Line 1
Residence Address Line 2
DOB(mm/dd/yyyy): City
State Zip
Is there more than one officer in the Business
User Information
UserID(4-20):
Password
Confirm Password:
I have read and agree to the Terms and Conditions
I authorize Total ePay and/or its representative to verify the information provided in this application, and to conduct ACH transactions in the bank account listed above.

    
 
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