Please complete the merchant account pre-application
form below. A merchant service specialist will contact
you within 24 hours to answer your questions and
help you get started. You must complete a printed/hard
copy of the full application before applying.
Or call us toll free
to apply by phone: 1-866-489-1319
Your
Contact
Information
Your Name:
Company Name:
Email:
Address:
City:
Website Address:
Phone Number:
Fax Number:
Cell Phone Number:
Best time to reach you:
Preferred
Contact Method:
Does
your business currently accept credit cards?
If
yes, what company currently handles your processing?
What
type of processing methods will you employ?
Select All that Apply
Internet/Online Credit Card Processing
Retail Store or Other Physical Location
Restaurant
MO/TO (Mail Order or Telephone
Wireless
Pay By Phone
Type
of Products or Services you provide
Anticipated
Monthly Visa/Mastercard Volume
Anticipated
Average Individual Sale
What
types of services do you currently use?
Select All that Apply
eCommerce Processing
Credit Card Processing
Gift Card Processing
Loyalty Card Processing
Check Processing
eCheck Processing
Wireless Processing
ACH Programs
Cash Advance
Payroll Services
Equipment
Free Gift Card Program
Recurring Billing
Pay by Phone
Other
When
do you anticipate needing your merchant account?
Make a Selection
Immediately
Within 1 week
Within 2-4 Weeks
Within 3 Months
Within 6 Months
Not Sure
Additional
Comments or Questions
If
you have a Promo Code, please enter it here:
Please
make sure you have filled out all fields before clicking
submit
