Electronic Card Processing, Inc. - New Merchant Account Application

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:

NO Credit, BAD Credit,
HIGH RISK Accounts,
NO PROBLEM!