Apply now for an Advanced Merchant Services account by simply filling out the form below.

* required information

Ownership Information
Owner Name *
Contact Name (if different)
E-mail Address *
Legal Business Name
Business Street Address *
City *
State *
Zip Code *
Business Phone Number *
Fax Number
Mobile Phone
About Your Business and Products Sold
Products Sold
Estimated Average
Credit Card Sale
Estimated Credit Card
Monthly Volume
Web Site Address
(if applicable)
Have You Ever Accepted Credit Cards?
What Kind Of Equipment Or Online System Do You Want To Process Your Credit Card Orders (Note: Banks Now Require Transactions To Be Conducted Electronically - Paper processing Is No Longer Available)
Equipment Needs

I need a Merchant Account

I need a Credit Card Terminal

I need a Check Imager

I need a Wireless Terminal

In addition, Please quote the following Value Added Services
Value-Added Services

Customized Gift / Loyalty Card Program

Electronic Check Conversion Guaranteeing My Checks

FREE Statement Analysis - I need to know if I have the most competitive rates in the industry!

CASH ADVANCE Program - I need an infusion of Cash (must be retail and have processed credit cards for a minimum of six months)

If Applicable, What info didn't we provde that you wish we did?
Do you want to accept American Express cards?
Do you want to accept Discover cards?
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