CardService Merchant Account Application

Price:	$99.95

Apply to accept Visa and MasterCard credit card payments.

Details:

Please fill out all of the following form. Leaving any boxes blank will delay your application approval.

The gateway license/setup fee will not actually be charged to your credit card until after your application has been approved.

After checkout, you will be prompted to download the Merchant Application Agreement file. You must write the words I Agree and sign your Full Name at the end of the agreement. Save the file to your desktop and then email it to support@ebizwebpages.com. Or you can fax it to 443-592-1492. We must receive that file back from you before we can officially submit your application for approval.

Apply to accept American Express cards? (recommended) (Yes/No):
Apply to accept Discover cards? (Yes/No):
Legal Name of Business:
DBA (Doing Business As) Name:
Customer Support Phone Number:
Authorized Company Contact (first & last name):
Title or Relationship:
Email Address of Authorized Contact:
Merchant Website Address:
Business Phone Number:
Business Fax Number:
Full Business Address:
Principle Owner's Full Name:
Social Security Number:
Date of Birth (mm/dd/yy):
Home Phone Number:
Business Ownership %:
Full Home Address (No P.O. Boxes):
Describe business and products sold in as much detail as possible:
Select your type of business ownership:
Home Based Business? (Yes or No):
Federal Tax ID #:
Average Monthly Sales Volume:
Average Sales Ticket Amount:
Bank Account Number for Deposits:
Bank Routing Number (9 digits):
Bank Confirmation - Enter all of the numbers at the bottom of your voided check except for the check #:

Quantity:

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