Apply for your Merchant Account with Nationwide Payment Systems
The Experienced Consultants
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
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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
Social Security Number
*
xxx-xx-xxxx
Website
https://www.yousite.com
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Processing Type
Card Present
Non-Card Present
B2B
E-Commerce
High-Risk
Other (please specify)
Terminal Type
Desktop
Wifi
Mobile/SmartPhone
Mobile
Virtual Terminal
E-Commerce
Other (please specify)
Additional Services
Gift Cards
Chargeback Programs
Merchant Financing
Consumer Financing
ATM
Accept Crypto
Other (please specify)
Business Type
*
Please Select
Retail
Restaurant
Bar/Club
E-Commerce
Mobile
Service
Healthcare
Mail Order/Telephone Order
High-Risk
B2B
Cash Discount
Other
Monthly Volume
Average Sale
High Sale
Notes
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Upload Voided Check
*
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Upload Driver's License
*
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Your Signature
*
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*
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