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Here is the information that we need to start your application for a new Merchant Account so that you can accept credit cards. After you fill out this form and hit the send button, we will forward this to our credit card processing company. They should have someone call you within 48 hours.   Please note: This is not available to non-U.S. dealers at this time.

Business Name:

Merchant Name/Contact:

Street Address 1:

Street Address 2:

City:

State:

             Zip:   

Email:

Work Phone #:

Work Fax #:

Home Phone#:

Home Fax #:

Best time to call:

Best Place to call:

(work or home)

Corporation:

(Y or N)

Sole Proprietor:

(Y or N)

Partnership:

(Y or N)

Time in Business:

Types of products sold:


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