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Home
Business Types
Retail
Restaurant
Salon
Grocery Store
Hardware
Resources
Areas Served
New York
New Jersey
About
Contact us
Terms
Sign in
888-860-8988
Card Processing Services Form
Merchant Application
Your Name
*
Phone Number
Your Email
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Your Company
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Subject
*
Your Question
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Submit
Name
*
Application Type
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New Merchant
Processor Change
Merchant Business Legal Name
*
As shown on your business income tax return
Business Name
*
DBA/Outlet Name
Federal Tax ID #
*
Employer Identification Number or Social Security Number
Physical Address
*
No PO Boxes
City
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State
*
Zip
*
Phone Number
*
Fax
Mailing Address
If different from Physical Address
(Mailing) City
(Mailing) State
(Mailing) Zip
(Mailing) Phone
(Mailing) Fax
Business Website
Year Business Established
Type of Goods or Services Sold
*
Market Type
*
Retail
Supermarket
Restaurant
E-Commerce
Health Care
Other
Quick Serve
Salon/SPA
First Name
*
Last Name
*
Title
*
Ownership %
*
Date of Birth
*
Social Security #
*
Residential Address
*
Full Name
*
Confirmation
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By checking this box, you confirm the above information to be correct.
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