emilyPay Full Application

Please complete our secure form to begin setting up your emilyPay merchant account

Legal Business Name

DBA Name(doing business as)

CRA/Gov Tax ID/Number

Business E-Mail Address

Business Phone Number

Physical Business Address

Business Start Date (Year, Month)

Name of Business Owner

Owner Personal Phone #

How Do You Take Payments?

Select One

Hardware Requested

# Wired Terminals - $10/mo

# Wireless(wifi)Terminals - $20/mo

Percent of Payments Is In-Person?

Percent of Payments Not In-Person?

Tip Option for Terminals?

Processing Information

Do you want to accept American Express(Amex)?

If you currently accept Amex, what is your Amex Monthly Card Sales in $

Monthly Total Credit Card Sales Revenue

Average Transaction size (ie., $500)

Minimum Transaction size

Maximum Transaction size

Frequency of Maximum Transaction/yr (Number of times per year)

Owners Drivers Licence

Choose files

Incorporation Document Showing Legal Name and Business Address

Choose files

Void Cheque for Direct Deposit of Funds

Choose files

emilyPay Terms and Conditions