RTO Pro Sign-up Form

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To speak with a sales rep
(724) 939-6591

Address

Physical Address Line 1 *

Physical Address Line 2

City *

State *

Zip *

Do you have a separate mailing address?

Yes

Mailing Address Line 1

Mailing Address Line 2

City

State

Zip *

Primary Contact

Person we can contact to ask questions regarding this application or ACH processing issues once your account is live.

Name *

Title *

Phone *

Email *

Billing Contacts

Monthly invoices will be sent to the email addresses provided below.

Same as Primary Contact

Name of Billing Contact #1 *

Title *

Business Phone *

Email *

Name of Billing Contact #2 (Optional)

Title

Business Phone *

Beneficial Owner Information

If no single owner has 25% or more equity, please identify the managing partner or executive.

Same as Primary Contact

Name *

Title *

Percentage Owned *

Business Phone *

Email *

SSN *

Date of Birth *

Driver's License *

State Issued *

Home Address Line 1 *

Home Address Line 2

City *

State *

Zip *

Transaction Information

The information below should reflect what you think your activity will look like in about 6 to 12 months.

How will you receive authorization from your customers to process payments via ACH? (Select all that apply) *

Contracts signed by my customers (PPD) contract with consumer / (CCD) contract with businesses

Verbal authorizations via phone calls (TEL)

Web signups with digital signatures (WEB)

What type of payments do you want to process via ACH? (Select all that apply) *

Debits (customer pays you)

Credits (you pay/reimburse others)

Purpose of Debits *

How frequently do you anticipate processing debit transactions? *

Number of debits per month you'll process *

Total value of debits you'll process in a month *

Largest single debit you'll want to process *

Purpose of Credits *

How frequently do you anticipate processing credit transactions? *

Number of credits per month you'll process *

Total value of credits you'll process in a month *

Largest single credit you'll want to process *

Bank Information

Please provide information for the bank account to use for processing your payments.

Bank Name *

Routing Number *

Account Number *

Do you want us to bill a separate bank account?

Yes

Please provide information for the bank account to use for your billing.

Bank Name

Routing Number *

Account Number *

RTO Pro Sign-up Form

Company Information

Address

Primary Contact

Billing Contacts

Beneficial Owner Information

Transaction Information

Bank Information