Send Your Application to Nationwide Payment Systems - NPSBank
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Name
*
Enter your Full Name
Email Address
*
myname@example.com
Phone Number
*
Format: (000) 000-0000.
Cell Phone
*
Format: (000) 000-0000.
Business Name (DBA)
*
Corporate Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Federal Tax ID (FEIN)
*
State of Incorporation
*
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Processing Type
Card Present
Non-Card Present
E-Commerce
Other
Business Type
*
Retail
Restaurant
Bar/Club
E-Commerce
Mobile
Service
Healthcare
Mail Order/Telephone Order
Monthly Volume
Average Sale
Terminal Type
Desktop
Wifi
Mobile/Smart Phone
Mobile
Virtual Terminal
E-Commerce
Other
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Upload Voided Check
*
Upload a File
Max Total Upload Size: 500MB
Cancel
of
Driver's License
*
Upload a File
Max Total Upload Size: 500MB
Cancel
of
Your Signature
*
Please verify that you are human
*
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Submit Application
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