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Merchant Application



(Check all that apply)

Credit and Debit Card Processing
Check Guarantee and Recovery
Gift and Loyalty Programs
Point of Sale Systems
Service and Support
Business Funding

SIC Code (if known)
Year Established
Average Card Sale $
Monthly Volume $
Card Present
Card Present (Note swiped)
Are the services requested for a new or existing business?

Type of Credit Card Processing

Retail Using Stand Alone Terminal
Retail Using Integrated Cash Register
Internet e-Store Using Shopping Cart and Related Software
Mail/Phone Order Using PC Software
Mail/Phone Order Using Stand Alone Terminal

What type of business?
Brief Description of Business
If using a credit card terminal, please indicate the following:


Is there any additional information we should know when considering your application to accept credit card transactions?