Home > Merchant Application Form

Page 1: Merchant Account Quote Inquiry Form:

 
 
 

Note that fields marked with an * are required.
 
Legal Business Name: *
First and Last Name: *
Location Of Business: *
Telephone #: *
Fax #: (If applicable)
 
You will need to login to our secure service to electronically sign your application/service agreement.

This should be your own personal email address, your login information will be sent to this email address.
You will also use this email and password "Resume Later" and our "secure service" features.
     
 
  E-mail: *
  Password: *
 
Referral code helps you to get promotional and discount offers.

please eneter only valid 'Referral Code', provider by your referral agent.
 
 
REFERRAL CODE:
 
Monthly Estimated Sales Volume (Visa MasterCard Sales "Please estimate") *
 
  High Volume or Multiple Locations ($100,000 and above)
  Low To Medium Volume ($0 - $100,000)
  Don't Know (Select this if your not sure.)
 
Type of Account (Select from the choices below) *
 
  Retail/Wholesale
  Internet/Ecommerce
  Mail Order/Phone Order
  Restaurant
  Business To Business (B2B)
  Mobile Business (Requiring wireless terminal)
 
How Would You Prefer To Receive Your Free Rate Quote?  
 
  Online Access (Approval through our automated approval system)
  Fax (Documents sent by fax) Much slower approval process
  Have A Merchant Account Advisor Call Me