Merchant Account Application

Please fill out the following quick application. We will contact you by the next business day and let you know if you qualify. This is a free service and there is no obligation.

We can accept only U.S. businesses. Adult businesses are not accepted. If your business is international or of a high-risk nature call us so that we may direct you to a provider. We can be reached at (817) 689-9055.

Please Note: The information you supply will be used only for the purpose of qualifying you for a merchant account. This information you provide is held in strict confidence and is never sold, rented, or shared with any other business or third party.

Business Name:
Business Address:
City, State, Zip Code:
Business Phone:
Business Fax:
Web Site Address:
Type of Business:
Business Start Date (MM/YY):
Please describe products or services sold in a few sentences:
Is the business based in the U.S., and does the owner have a U.S. SS#?
Do you currently process Credit Cards?

Average ticket per sale:
Anticipated monthly card sales volume:

Order sources? (must equal 100%) In person sales (card is present & swiped) % Internet/Mail/Phone sales (card is not present) %
Owner's credit:

CONTACT INFORMATION
Contact Name:
E-mail Address:
Best numbers to reach you at:
Best time to call:
Time Zone:
How did you find us?

Have you called us and spoken with anyone?

PROCESSING OPTIONS

Option interested in (check all that apply):

Authorize.Net Internet Processing
PC Charge Software
Point of Sale Terminal
Wireless
Other / Have my own processing equipment (please specify type):
Unsure

Notes or Comments:

For more information on our rates, packages, and equipment, call Internet Sales Department at
(817) 689-9055

SPEAK TO AN
MERCHANT EDUCATOR

Prefer to speak to an Merchant Educator regarding a Merchant account with Smart Card Systems? Please provide your contact information and we'll contact you within 24 hours!