High-Ticket Processing Application

Holistic Payments

Section 1 of 5

Business Background

Tell us about your company and what you do.

Company Name *

Your Name *

Email *

Website URL

Business Type *

Coaching Consulting Agency Course Creator SaaS Events / Retreats Other

Entity Type

Time in Business

Section 2 of 5

Offer and Sales Model

Help us understand how you sell and deliver.

Describe your primary offer *

Price Range *

$1K - $3K $3K - $5K $5K - $10K $10K - $25K $25K+

Do you offer payment plans or financing?

Yes No Want to start

Sales Process

Sales calls Webinar funnel VSL funnel Application funnel Self-checkout DM / Social selling

Delivery method

1-on-1 calls Group coaching Online course Done-for-you Hybrid In-person

Section 3 of 5

Transaction and Volume

Numbers help us match you with the right processor.

Monthly Revenue *

Average Transaction Size

Current chargeback rate

Under 0.5% 0.5% - 1% 1% - 2% Over 2% Not sure

Refund rate

Under 5% 5% - 10% Over 10% Not sure

What's your refund policy?

Section 4 of 5

Current Processing Setup

Where are you processing payments now?

Current processor(s)

Stripe PayPal Square Authorize.net NMI None yet Other

Have you ever been terminated by a processor?

No Yes

Do you currently have funds held or in reserve?

No Yes

What rate are you currently paying?

What platform do you use to collect payments?

ClickFunnels Kajabi GoHighLevel Teachable Thinkific Shopify Custom site Other

Section 5 of 5

What You Need

Help us tailor a solution for you.

What's most important to you? *

Lower rates Chargeback protection Payment plan support Faster payouts Backup processor International payments

Payment methods needed

Credit / Debit ACH / Bank transfer Wire transfer Crypto Buy Now Pay Later

Anything else we should know?

Application received.

We'll review your details and reach out within 1-2 business days to discuss next steps and your custom rate.