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      Merchant Account Pre-Application

      This form is 100% secure and confidential and does not obligate you to use our services.

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 Merchant Account Pre-Application
(Secure Form, Confidential)

Please fill out the CONFIDENTIAL MERCHANT INFORMATION Pre-Application form below. Upon receipt of the information, we will contact you and completely clarify any additional questions you may have, including questions related to setup fees, discount rates, product investment costs, etc. You be the final judge.

You shall then receive the final documents for your approval via overnight mail.

Welcome to Cardservice International.

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Pre-Application

If you would rather not submit certain information over the Internet, please complete the form with as much information as possible, and we will contact you over the telephone to get the rest. Please double-check your telephone number.

Business Information

Legal name of business:

Contact:

DBA (doing business as):

Telephone Number:

Fax:

Street address:

City:

County:

State:

ZIP:

Mailing address (if different than above)

Address:

City:

County:

State:

ZIP:

Type of business (be specific)

Federal tax ID # (if available):

Estimated average monthly
MC/Visa volume:

$ (ex. 10,000.00)

Age of business:

years months

Estimated average
ticket/sales amount:

$ (ex. 12.50)

Highest estimated ticket amount:

$ (ex. 500.00)

Current URL (if applicable):

Type of ownership:

Ownership Information

Principal's legal name:

Ownership %:

Home telephone:

Social Security number:

Driver's license number:

State:

Exp. date:

Home address:

City:

State:

  ZIP:

How Long?

years months
Own Rent

Date of birth:

mm/dd/yy

E-mail:

Current Processing

Current/previous processor
(if applicable):


Current merchant numbers:

Amex

Discover

Diners

Comments or Questions?

Comments/Questions                                                     

Best time to call

Hardware/software area of interest
 


If other, please specify:

 


(may take a moment, please be patient)

 

Contact Us

SiteMaven Design
Direct Dial: (620) 653-4377
Fax: (815) 346-8947
E-mail:sales@sitemaven-design.com
563 W. Broadway Ave.
Hoisington, KS 67544

Privacy Policy.

guarantee.jpg (3738 bytes)
Guaranteed approval
satisfaction
or 100% money back.

Cardservice International is a registered service provider for the following FDIC-insured banks: First Financial Bank, Atlanta, GA; Humboldt Bank, Eureka, CA; Redding Bank of Commerce, Redding, CA; Tehama Bank, Red Bluff, CA. Debit Sponsor: Carrollton Bank, Baltimore, MD. American Express and Discover require separate approval.

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