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Paya Application

Business Legal Name *

Exact name on bank account

Tax ID (EIN, 9 digits) *

Website URL *

Business Address *

Address *

Address line 2 *

City *

State *

ZIP Code *

Business Phone *

Contact Person

Contact Person Name *

Contact Person Phone *

Contact Person Email *

Owner Information

Owner Name *

Owner Email *

Owner Phone *

% of Ownership *

Must own 25% of more of the company

SSN *

This is needed for a credit check

Owner Address *

Address *

Address line 2 *

City *

State *

ZIP Code *

Transaction Information

Average Transaction Amount *

Maximum ACH Amount Per Transaction *

What might be the maximum dollar amount you might receive from a customer?

ACH Transactions Per Month *

Estimated Monthly ACH Volume *

Voided Check or Bank Letter

Bank Statement (1 month)

Upload a current processing statement or business license or utility bill

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