HOME CART eSECURITY MOBILE E-COMMERCE INT'L. ACCT MARKET SUPPORT APPLICATION CONTACT

Credit Card Order Form
See On-Line Checks

Order Information

	Order:
	Subtotal:
	Shipping:
	Sales Tax:	% Tax Exempt
	Total Amount:

Pay by:

Credit Card

Check

	Supported card types:
	Transaction type:
	Credit card number:
	Expiration date:	/
	Card Code:	Code not on card

Reference # (Forced Ticket):

Customer Contact Information

Customer name:

Billing street address:

Suite. or Apt.

City:

State:

Zip Code:

Phone:

Email:

Shipping

Copy billing address?

Yes

Ship to this person:

Shipping street address:

Suite. or Apt.

City:

State:

Zip Code:

Comments:

Chuck Taylor
eCommerce Solutions
Retail & Contractor Merchant Accounts
Bank & Credit Union Merchant Accounts

450 N. Sam Houston Parkway
Suite 273
Houston, Texas 77060-3551
Tel.: 800-948-6457
Fax: 877-609-7766

HOME CART eSECURITY MOBILE E-COMMERCE INTL..ACCT MARKET SUPPORT APPLICATION

First Data Independent Sales is the leading eCommerce Merchant Account solution service provider building on a decade of excellence. Last year the company serviced over 161,000 merchants and processed over $12 billion in bank card volume. With an estimated bank referral program featuring over 100 financial institutions and an industry recognized partnership with First Data Corporation. Cardservice International service from the efficient establishment of a merchant account to technologically sophisticated terminals and secure payment gateways, demonstrates a firm commitment to provide the very best service in the credit card transaction processing industry today. Cardservice International provides the expertise and reliability to enable merchants to accept credit cards, ATM/debit cards and checks. Our highly trained, multilingual Customer Service Representatives offer merchants the highest standard of service equipped with advanced computerized technology, we are providing merchants with accurate information and can answer processing inquiries in 140 languages and dialects.

Services by Cardservice International.

All trademarks, service marks and trade names referenced in this material are the property of their respective owners. The First Data Independent Sales Agent Program is operated by Cardservice International, Inc. Cardservice International, d/b/a First Data Independent Sales is a registered ISO/MSP for Wells Fargo Bank, NA, Walnut Creek, CA, an FDIC-insured bank. American Express® requires separate approval. The Eclipse terminal and its payment processing system are the subject of U.S. and International patents pending. VeriFone® is a registered trademark of VeriFone, a division of Hewlett-Packard Company. All other brand names and trademarks appearing in this specification sheet are the property of their respective holders.
FDIS Texas is an independent Agent Office for Cardservice International.

Credit Card Order Form See On-Line Checks

Credit Card Order Form
See On-Line Checks