Merchant Account

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 Please complete the FREE Merchant Account pre-application below.
Or call,  Chuck Taylor  @  800-948-6457   9 - 5 pm Central Ext. 18
IMPORTANT:  To be approved to accept Visa, MasterCard, Amex, Diners & Discover.
1. You must have a valid Social Security or Federal Tax ID Number and be at least 18 years of age.
2. You must have a business checking account with a U.S. Bank or Credit Union.

Express(24hrs.) Pre-App.

Referred By:
Your Busn. Name:
Phone Number: 
Cellular Number: 
Fax Number:
Business Details
Type of Ownership: 
Product or service based business: Product  Service Both
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:
Percent Equity Ownership:
How would you rate your credit ?
Other Optional Questions
Start up is planned in.
Will your product be shipped ? Yes  No
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
Merchant Services		 450 N. Sam Houston Parkway  
Suite 273
Houston, Texas  77060-3551
Tel.: 800-948-6457
Fax: 281-445-7257