PLEASE FILL OUT THE INFORMATION BELOW, A MERCHANT SPECIALIST WILL CONTACT YOU IF ADDITIONAL INFORMATION IS NEEDED TO PROCESS YOUR APPLICATION.
(NOTE: This application is for US-Based Businesses Only!)
Select Processing Services:
(check all that apply)
Credit Card
ATM/Debit Card
Electronic Check Processing
Check Truncation
E-commerce Processing
EFT(Electronic Funds Transfer)
International Merchant Processing
If you are interested in processing credit cards,
please indicate which ones you would like to accept:
Visa/MasterCard
American Express
Discover
Bankcard Estimates:
Average Ticket Amount $:
Est. Monthly Credit Card Volume $:
Processing Method
(Sum of Processing Method must equal 100%):
Card Swipe
%
Manually Keyed
%
Phone/Mail Order %
Internet %
About Your Business:
Business Owner/Contact Name:
Legal Business Name:
Street Address:
City, State, Zip:
Business Phone:
Business Fax:
Email:
How Long Have You Been In Business?:
Years
What industry are you in?
Type of Processing Equipment Desired:
Credit Card Terminal
E-commerce Processing
Reprogramming for Existing Merchant Account
Looking to:
Buy the Equipment
Lease the Equipment
Comments:
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