Merchant Funding Application

Please complete the below form and we’ll arrange a quote for you based on this information.

Your Name (required)

Business Name (required)

Your Email (required)

Your Telephone (required)

Do you currently accept card payments? (required)

Who is your current Merchant Account Provider? (required)

How much do you turnover on cards each month? (required)

Have you accepted cards for at least 6 months? (required)

What do you plan to use Merchant Funding for?

How much are you looking to borrow?

We'd like to keep you up to date with news, events, products and services from Chip & PIN Solutions. Please tick this box if you are happy for us to stay in touch by email and telephone: YesNo


Please see our Merchant Funding terms and conditions.  By submitting this form you are agreeing for a Chip & PIN Solutions representative to contact you to discuss your requirements.