Secure Merchant Application

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Secure Online Merchant Account Application

Congratulations! Your are on STEP-2 of your Retail Merchant Account Application.

Step-2: Your Information:

Your information is kept private and secure.
This form uses 128 bit SSL Secure Servers!

If you have questions, call 1-866-999-6632 or E-Mail us

Legal name of business:
First Name: *
Last Name: *
DBA
Email Address: *
Telephone Number: *
Fax:
Street address:
City:
State:
Zip:
Country:
Type of business:	Describe the type of business you will use this merchant account for. (Ex. I sell shoes...)
Estimated average monthly MC/Visa volume:
Highest estimated monthly MC/Visa volume:
Estimated average ticket/sales amount:
Highest estimated ticket amount:
Your website URL (if applicable):
Type of ownership:	Proprietorship Partnership Corporation Other
Principal owners' legal name:
% (percent) Ownership:
Home telephone:
Home address:
City:
State:
Zip:
E-mail:
Comments or Questions:

Your information is kept private and secure.
This form uses 128 bit SSL Secure Servers!

QUESTIONS?

If you are having trouble with the above form, please contact us. We can answer any questions you have and get your application into the approval process. You can either use the email button below to submit your question or you can call us at: 1-866-999-6632

© 2006 Cardservice International, Inc. All rights reserved. | Privacy Policy
Cardservice International is a registered ISO/MSP for the following FDIC-insured banks:
First Financial Bank, Englewood, CO; Wells Fargo Bank, N.A., Walnut Creek, CA.
Cardservice Agent # 16560 is an independent agent of Cardservice International.
Phone: (866) 999-6632 - 69 East 800 North, Spanish Fork, UT 84660
Send general questions to: support@CardserviceInternational.com or fax: (866) 794-3002