Filling out this form does not obligate you to our payment gateway. You can cancel at any time.

Legal Name of the Business (Example: Abe's Sandwich LLC)(Required)

Business Address(Required)

DBA Name of the business (Example: Subway)

DBA Business Address

EIN / Fed Tax ID

If this is your Social Security Number, skip this field. You’ll have a chance to fill it in later with MPC.

Short Description of What You Sell(Required)

Will you have subscriptions or recurring payments?(Required)

Yes

Unsure

Please provide your "Recurring Payment" opt-in disclosure statement.

You may leave the text below if you will not have recurring payments. Otherwise, please replace the text with your Recurring Payments/ Negative Option/ Free Trial: Opt‐in/Click to Accept with disclosure statement and clear cancellation policy.

What is your "Shipping Policy", if you ship products.

Please view our sample and note anything that differs. Must include: timeframes for order processing, explanation of shipping options, and expected delivery timeframes. If you provide digital products, you can explain your policy on time to download, copyrights, etc. Sample

Average Ticket Amount(Required)

Estimated Annual Sales(Required)

Please provide any "Terms & Conditions" specific to your products or services.

View our sample and provide anything that differs. Must include the terms of usage of the website and all its content. Sample

Please provide anything specific you'd like to include in your "Privacy Policy".

View our sample and provide anything that differs. Must include: What customer data is collected and tracked, with whom this information is shared, and how customers can opt out. Sample

Please explain your "Refund Policy".

View our sample and provide anything that differs. Must be disclosed by the merchant before the sale is completed. If the merchant has a limited refund policy (i.e. no refund, exchanges only, all sales final, etc), it must be clearly identified in this policy. Sample

My business or non-profit is responsible for purchasing the licenses to make the gateway function. CourseVector or Merchant Pay Connect will email me a list of licenses needing to be purchased.(Required)

I Agree

My business or non-profit will email the licenses to support@coursevector.com(Required)

I Agree

I understand that the "Terms & Conditions", "Privacy Policy", "Returns Policy", "Shipping Policy", and any other website content is my responsibility. CourseVector may help get it set up, but responsibility lies with my business or non-profit to verify the efficacy or legality of any website content.(Required)

CourseVector recommends reviewing any “legal” content with your lawyer prior to the site going live.

I Agree

My business or non-profit understands that there may be fees if a minimum of $50,000 is not processed within a 1-year period. If the minimum processed volume is not reached by the end of the 12-month period the business or municipality will be required to pay a minimum fee, outlined below. Please read the Merchant Pay Connect documents carefully before signing, as the terms and conditions may vary from what is outlined below.(Required)

1. Business or Municipality processes less than $24,999 within the 12-month period, a $700.00 minimum fee will be billed. 2. Business or Municipality processes between $25,000 and $49,999 within the 12-month period, $350.00 minimum fee billed. These fees are negotiated between the business or municipality and Merchant Pay Connect and are listed here only for full disclosure.

I Understand

Signature(Required)

I understand that my signature here is a legal representation of my signature and is legal and binding.

Name of Signed(Required)

First Last

Email(Required)

Business or Municipality Name(Required)

You will be forwarded to the Merchant Pay Connect secure message system upon clicking submit.

MPC needs a copy of your driver’s license, social security number, copy of a voided check, and copy of a processing statement. DO NOT SEND THESE VIA EMAIL. Use the secure message system. Please be patient. It may take a few seconds to complete the redirect.

Learn more about how CourseVector can connect your business to potential clients.

Learn more about Merchant Pay Connect.

Not quite ready to sign up? Contact us for more information or to schedule a live demo.

Payment Gateway Interest Form

You will be forwarded to the Merchant Pay Connect secure message system upon clicking submit.

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