TheraOffice
Please complete the enrollment form below to set up an Account and Merchant ID with SwervePay to initiate Implementation of TheraOffice PAY. 
Business Information






If different from legal name






If your account will be enabled with Texting options, this will be the area code sent with number to message recipient.

Other Business Information


Sole Proprietor, Partnership, Corp, LLC, Non Profit, Other

Dental, Optometry, Family Medicine, etc.

If you do not have a website for your business, please include a URL that references your Business.


The date your business was registered with the state in the form mm/dd/yyyy

How much is your average transactions (e.g. $50.00)

This is monthly not annually.
Business Bank Account Information
As a default, this information will be used for funding (settlement) as well as drafting for fees incurred.  A test transaction for an amount less than $2.00 will be run during your account configuration in order to determine proper routing. You will receive an email from "support@swervepay.com" reminding you to confirm settlement of that test transaction. 

NOTE: Invalid Bank information will result in ACH Return Fees. 


This is the 9 digit number on your check.

This is the 9 digit routing number on your check.




BUSINESS OWNER 1 (Or Authorized Signer) INFORMATION
FinCEN is issuing the CDD Rule to amend existing BSA regulations in order to clarify and strengthen customer due diligence requirements for certain financial institutions. The CDD Rule outlines explicit customer due diligence requirements and imposes a new requirement for these financial institutions to identify and verify the identity of beneficial owners of legal entity customers, subject to certain exclusions and exemptions. 




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

BUSINESS OWNER 2 INFORMATION (If ownership is 25% or greater)




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

BUSINESS OWNER 3 INFORMATION (If ownership is 25% or greater)




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

BUSINESS OWNER 4 INFORMATION (If ownership is 25% or greater)




mm/dd/yyyy







mm/dd/yyyy

mm/dd/yyyy

Exhibit A - Pricing Schedule
Software & Merchant Services Monthly Fees:  
  • 2.95% Processed Volume on Non-Swipe Transactions
  • 2.55% Processed Volume on Swipe Transactions
  • $0.30 Per Transaction
  • $30.00 Monthly Minimum Fee (only charged if monthly processing fees are less than $30.00)
  • $25.00 PCI Non Reporting Fee
Per Transaction Fees:
  • $130.00 Per Device
  • $15.00 ACH Return Settlement Return Fee
  • $35.00 Chargeback and Retrieval (Dispute) Fee
SwervePay is a Level 1 PCI Certified provider and is recognized as such on Visa's website (https://www.visa.com/splisting/). SwervePay is also a Registered Payment facilitator and recognized as such on MasterCard's website (https://www.mastercard.us/en-us/merchant/start-accepting/payment-facilitators.html).
Device Ordering and Fulfillment

USB / PCI Compliant Credit Card Swipe with KeyPad from IDTech - M130

Would you like to take credit card payments in your office? Or consolidate both merchant accounts into one, easy-to-manage account with SwervePay? You can order an in office terminal from IDTech that easily plugs into a USB port and is PCI compliant. 

  • IDTech M130 devices are recommended for clients intending to take in office payments. 
  • The devices support both swipes and manual entry and provide additional protection of cardholder data.
  • IDTech M130 devices are supported to be used in both the SwervePay and SolutionReach applications for any in-office payments.
  • Devices will be shipped to the Business Contact and Business Address listed above unless otherwise specified. 


Customer Service Contact Information


Primary User Initial Setup
This will be the initial user that will receive the SwervePay login information. 



Signer Information




Finalizing Your Application 

Submitting your application will begin our account setup process.  Next steps include: 
  1. We will configure your Account. (If any additional information is necessary, a representative will reach out from "underwriting@swervepay.com").
  2. If devices are ordered you will receive an email confirmation with tracking information from "support@swervepay.com".
  3. A test transaction will be run to ensure that your funds are routing to your bank account.  You will receive an email from "support@swervepay.com" to verify that you see the test transaction deposit.
  4. We will set up an administrative user in the SwervePay Portal and provide credentials to the user provided in the Primary User Initial Setup section above.

Note: For questions regarding the SwervePay Agreement and/or Terms please contact "legal@swervepay.com".  Any other questions please contact TheraOffice Sales at 630-455-1863 extension 1.