New Merchant Application

Sales Partner Information

Sales Partner Full name

Sales Partner Phone

Sales Partner Email

Client Information

Name of the Business

Address

Street Address

City

State

Country

Postal Code

Business Owner First Name

Business Owner Last Name

Business Owner Phone Number

Business Owner Email *

Monthly Card Volume *

Average monthly card volume?

Set up fee? *

Se-up fee Amount$ *

Set up fee amount *

Other amount

Select Equipment *

Other Equipment - Please provide details

Please advise on which equipment your merchant needs. If unsure, please type "unsure" and we will contact you to confirm.

Additional Comments *

Anything else we should know about this merchant so we can provide the best experience for them?

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