NxGen DataWedge
Credit Card Processing Pre-Application
Please fill in the applicable fields below, then click the SUBMIT button located at the bottom of this page. The below form must be completed in full in order for us to prepare application materials for the underwriters.

In addition, please FAX to us at 925-892-5968 the following items required by the Nova underwriters:
  1. A blank, voided CHECK for the account into which you want funds deposited. The check must include either the Corporate name or the DBA name printed on it. If you are a new business and have not yet received your checks from your bank, ask your bank to write a letter on their letterhead stating that your account is open and active, and giving the account number and bank routing number. This letter must then be signed by a bank officer. (This is a very routine request for a bank and they probably have a form letter available for the purpose).
  2. If you are currently receiving services from another credit card processor, fax to us copies of three recent months' statements from that processor. The statements must be complete (all the pages must be included, even if they don't seem important), the statements must be for sequential months, and they should be within the last several months.
  3. In order to comply with Federal Reserve banking security requirements when opening a credit card merchant account for a location where neither we nor the bank has personally been on site, we must have copies of either (a) a local business license or (b) a state tax certificate or (c) state incorporation papers. Any ONE of these documents will do, but they must be in the name of either the corporation or the DBA name.
  4. Once we have received the complete form and all required attachments, we will prepare a formal application which must be signed by at least 50% of the ownership. We will call you prior to faxing the forms so that we may answer any questions you have. We will fax the forms to you for signature, you will fax the signed forms back to us, we will forward them to the underwriters. Once in the hands of the underwriters the approval process generally takes about 5 business days. Underwriting then forwards the approval to another department that sends us special coding necessary to initiate the merchant account in the DMS software. DataWedge technical personnel will then call in to your system to insert the codes, a process that takes only a few minutes.
PLEASE ALLOW 10-14 BUSINESS DAYS FOR PROCESSING

PLEASE FEEL FREE TO CALL US AT ANY TIME AT 208-874-4185 x3 WITH QUESTIONS
Please check the following that apply:
New Merchant Additional Location-Existing MID
Business Information
Business Name (DBA):
Physical Address:
City: State: Zip:
Email Address:
Business Phone: Business Fax:
Business Contact Person:
Corporate Name:
Corporate Address:
City: State: Zip:
Corporate Phone: Corporate Fax:
Corporate Contact Person:
Prefer statements sent to: Corporate Address Business Address
Current Card Processor: Number of Years with Current Card Processor:
Time Zone:
Ownership Information (need 50% or more ownership)
Name:
Title: Ownership:%
Date of Birth:
Home Address:
City: State: Zip:
Home Phone:
Name:
Title: Ownership:%
Date of Birth:
Home Address:
City: State: Zip:
Home Phone:
Business Profile
Services/Products:
Federal Tax ID:
Business Structure:
Year Established: Length of Current Ownership: Years Months
Prior Experience: Yes No Years of Prior Experience:
Are you party to any claims or lawsuit? Yes No
Have you ever declared bankruptcy? Yes No
Have you ever had a credit card contract terminated by another processor? Yes No
If yes to any question above, please attach an explanation via fax.
Current Accounts
Do you have a current merchant account with American Express? Yes No
If yes, what is your American Express merchant number?
If not, do you want us to open an American Express account for you? Yes No
Do you have a current merchant account with Discover? Yes No
If yes, what is your Discover merchant number?
If not, do you want us to open an Discover account for you? Yes No