Merchant Account

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 Please complete the FREE application below.
Or call,  Chuck Taylor  @  800-948-6457   9 - 5 pm Central Ext. 18

Express Pre-App.

Referred By:
Your Busn. Name:
Phone Number: 
Cellular Number: 
Business Details
Type of Ownership: 
Description of products or services provided:
Amount of Average Sale:
Estimated Monthly Visa/MasterCard Volume:
Web Site Address (URL)
Contact Information
First Name:
Last Name:
Email Address:
Home Phone:
Best Time To Reach:
How would you rate your credit ?
Other Optional Questions
Start up is planned in.
Are there any additional services you would like information on? Gift Card Program
Web Site Hosting
Shopping Cart For Your Website
Design & Web Development
Federal EIN Number

Description of Business:

Note:  By pressing Submit or Faxing, the applicant authorizes an investigation of the applicant's credit history with various credit reporting and credit bureau agencies for the sole purpose of determining the approval of the applicant for merchant status or equipment leasing.   This information is kept strictly confidential and will not be released. American Express, Diners and Discover card require separate approval processes. There is no extra  charge for the American Express application.
  Chuck Taylor
Sr. Account Exec.
eCommerce Solutions
Retail & MOTO Merchant Accounts
Bank & Credit Union Merchant Accounts

450 N. Sam Houston Parkway Ste. 273
Houston, Texas  77060-3551
Ph:   800-948-6457
Fax:  281-445-7257

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