Free Credit Card Terminal
services processing payment retail Cheapest Company

Internet & Mail Order / Telephone
Merchant Application

Affiliates

Merchant Information
 
Legal Name of Business DBA
   
Street Address
(Physical Address - No P.O. Boxes)		 City State ZIP Code
       
Mailing Address
(If Different from Street Address)		 City State ZIP Code
       
Business Telephone Number Business Fax Number
() ()
   
Tax ID Number Number of Years
in Business
years months
   
Authorized Business Representative Merchant E-Mail
   
List Type of Business / Products / Services Sold
(Be Specific)		 Merchant URL
(if applicable)

Ownership
51% ownership for a corporation, 100% ownership for a partnership or proprietorship, must be accounted for on the application: 
 
Principal's Name Ownership % Title
Date of Birth Social Security Number
/ /
Driver's License Number / State Issued ID Number Issuing State Year Expiration
Street Address City State Zip Code
Home Phone Number
()
Second Principal's Name Ownership % Title
Date of Birth Social Security Number
/ /
Driver's License Number / State Issued ID Number Issuing State Year Expiration
Street Address City State Zip Code
Home Phone Number
()

Processor
Are you now processing or have you ever processed MasterCard/Visa?
Have you ever had a bankcard relationship terminated?
 
Average Combined Monthly Volume Average Ticket/Sales Amount

E-Commerce (Optional)
 
Web Hosting
($20.00 one time set-up fee)		 Web Design Shopping Cart
($25.00 one time set up fee)

Internet Payment Gateway *Required For Internet Merchant Accounts*

Secure Internet Processing Gateway (No Installation Necessary)
Promo Code (if applicable)


 
Copyright 2003 Pay-It Online, LLC & Cardservice International. All Rights Reserved.

MerchantAccounts4Less.com is a Pay-It Online LLC owned site. Visit us at www.pay-it.com.

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.

American Express and Discover require separate approval.

Merchant Accounts 4 Less