Payment Processing Application

Please complete the below form.  All fields are required unless otherwise noted.  If a particular field does not apply, please use "N/A" to indicate such.

All data shared with Mixed Media Ventures will be used only to establish a business relationship with your organization and a new host payment processor that will suit your requirements.  Once submitted, a representative will contact you within 24 hours to have a deeper discussion.

Detailed Payment Processing Request

Please separate different organizations with commas.
Your Net Promoter score, Explanations for Negative Posts, BBB Ratings, etc.)
What major brands does your business sell and/or what services does your business sell?
What industries do you sell into today. Please be specific and provide full descriptions where necessary.
What is the average merchant revenue per month and/or annually. Please be as specific as you can be.
Please list credit, debit, gift, loyalty, and/or other
Please provide link or details.
Can you process for any of the following high risk merchants: ring-tones, downloads, medical marijuana, gaming/gambling, adult, (list other high-risk examples).
Please provide any other information you might want us to know about prior to contacting you.