Pre-application for Merchant Accounts. One of our sales representatives will contact you within 24 hours.

PRE-APPLICATION MERCHANT FORM

* indicates required fields

*Type of Payment Method:  Credit Cards  Credit Cards & ACH  ACH Low Risk  ACH High Risk  POS Retail

*Type of Account required:  International Account  American Account  Canadian Account  European Account

*Name of Business:

*Contact Name:

*Contact Email:

*Business Address:

*State/Province:

*Zip/Postal Code:

*Daytime Phone:

Business Fax:

*Legal Name of Business:

*Principal Owner:

*Type of Product or Service Sold:

*Age of Business:

*What credit cards do you currently accept?:  Visa & MasterCard  MasterCard  Visa  None

*Who is your current processor:

*Indicate Monthly Visa and MasterCard volume:

*What is your average sales ticket:

*What is your website url:

*Which country are you incoporated in?:

*What percent is your monthly chargebacks?:

*Direct or 3rd Party Account (new business):  Direct Account  3rd Party

*Comments: