MERCHANT ACCOUNT PRE-APPLICATION(Note: Items in red are required)
Please fill out the following information about your business and we will contact you within 24-hours:
Contact Name
Business Name
Business Address
City
State (U.S. Only)
Select a State Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Business Phone
Fax
Mobile Phone
Best Time to Call
Website Address (If any)
Email Address
Please tell us about how you will be accepting credit cards:
Type of Merchant
--None-- Retail/Card Swipe Mail Order/Phone Order Internet/Shopping Cart
Equipment/Software Needs
Equipment Software Needs Credit Card Terminal - No Printer Terminal with Thermal Printer Terminal and PinPad Terminal and Check Reader Terminal, PinPad, & Check Reader Transaction Manager Software Cellular Credit Card Terminal Internet Payment Gateway
Average Ticket Size
Average Ticket Size $100 or Less $100 - $500 $500 - $750 $750 - $1000 $1000 or More
Average Monthly Volume
Projected Monthly Credit Card Volume Less than $5,000 Volume $5,000 - $10,000 Volume $10,000 - $25,000 Volume $25,000 - $50,000 Volume $50,000 - $100,000 Volume $100,000 & More Volume
Merchant Credit Processing Solutions - 2700 Dawson Avenue, Signal Hill, CA 90755Office (866) 287-7657 - Fax (866) 287-7687 - Email info@merchantcreditprocessing.com