Card Processing Systems

Merchant Services
Online Application
Print Application

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Application
Schedule A

Merchant Account Online Application

Two easy ways to apply fill out the online form below, or Click Here to print the application and fax it to us at 914.472.9082. Thank you.

MERCHANT INFORMATION
Business Legal Name ---Is Your Business Seasonal? Yes No
Mailing/Billing Address ---City ---State
Zip ---Phone --- Fax
Tax ID # ---Total # of Locations
Merchant Doing Business As Name
Business Start Date --- How Long At This Location?
Location Address (No P.O. Box) ---City --- State
Zip --- Phone --- Primary Merchant Contact
Email Address
Type of Ownership Sole Ownership Partnership Joint Venture LLC Public Corp Private Corp Govt. Corp Non-Profit Other
Website
American Express Merchant # (If you want to use existing American Express Number)
OWNERS/OFFICERS List the Two Owners with the Largest Share of Ownership
1. Name --- Title --- Percentage of Ownership %
Residence Address --- City --- State
Zip --- Home Phone --- Social Security #
Date of Birth -- State

2. Name --- Title --- Percentage of Ownership %
Residence Address --- City --- State
Zip --- Home Phone --- Social Security #
Date of Birth --- State
CREDIT INFORMATION
Annual Visa/Mastercard Volume
Average Credit Card Ticket
Total Sales
BANK REFERENCES
Bank Name
Transit Routing # (ABA #)
Account Number -
Address
City
State
Zip