Get Started – BluVyne

Please complete and submit this form. A representative will contact you shortly to complete the merchant application process.

Business Information
^Indicates required field*
Legal Business Name^*		Doing Business As Name (DBA)^*
Physical Address (No PO Boxes)^*		Mailing Address (if different)


Phone Number ^*	Business Fax	Business Email^*
Type of Business (What do you sell?)^*		Company Website
Principal Contact Name^*		Monthly Dollar Volume^*	Average Ticket Size^*
Principal Contact Email^*		Number of Employees^*	Date Your Business Started ^*
Principal Contact Phone^*		Ownership Type^*
Do you already own any credit card equipment? Please describe what you have.		How do you make sales? Select all that apply.^* In my store or restaurantOn my websiteOver the phoneI need a mobile solutionOther
Owner/Principal Information
Owner/Principal Name^*		Ownership %^*	Cell Phone Number^*
Home Address (No PO Boxes)^*		Owner/Principal Title^*
		Owner/Principal Email^*
Additional Comments: The information you provide on this form will be kept strictly confidential and will only be used to prepare the appropriate merchant account documents that will be sent to you for your approval via secure link.