Referred by AmericanCentralStore.com

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Your Name* This field is required. Have a question, feel free to call us at 800-570-1347
First Name
Last Name
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Email* This field is required. Have a question, feel free to call us at 800-570-1347
example@example.com
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Phone Number
Area Code
Phone Number
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Do you currently already have a merchant account and just looking for the NMI Gateway?
YESNO
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Are all owners' USA Citizen(s)?* This field is required. Have a question, feel free to call us at 800-570-1347
YESNO
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Why are you applying for a new merchant account, and what is most important to you about this new merchant account?* This field is required. Have a question, feel free to call us at 800-570-1347For example, “need additional volume, the ability to seamlessly integrate with our XYZ shopping cart CRM is most important”
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List URL(s), web sites:* This field is required. Have a question, feel free to call us at 800-570-1347What is your website address?
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Please describe your product or service:* This field is required. Have a question, feel free to call us at 800-570-1347For example: MLM, affiliate, one time sale, recurring billing:
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Legal Company Name:* This field is required. Have a question, feel free to call us at 800-570-1347
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Company Country(s) of registration:Where is your company located?
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Owners` name(s):* This field is required. Have a question, feel free to call us at 800-570-1347
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Owners` citizenship / Countries of legal residencies:
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Have you accepted credit cards before?* This field is required. Have a question, feel free to call us at 800-570-1347With this business or any business?
YESNO
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If yes, with whom have you accepted credit cards with before, and for how many months?
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Please upload your last 3 months of prior processing statements:
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Max. file size: 10.6MB
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Have you applied with anyone in the last 12 months? If so, with whom?* This field is required. Have a question, feel free to call us at 800-570-1347Anytime you have filled out or signed an application.
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Have you had a merchant account shut off, if so for what reason? Have you ever had a decline from a processor?* This field is required. Have a question, feel free to call us at 800-570-1347With this business or any other business?
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What is your estimated credit card processing volume this month?Months 3, 6, 12?
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Is the highest transaction you would process over $1000?
YESNO
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If it were less complex to be approved at a lower maximum sale amount would you be open to processing higher sales through a separate account?
YESNO
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Processing currencies required or requested:For Example: US Dollar, EUR
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Countries marketed to with percentage:For Example: USA 90%, New Zealand 10%
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Is this a discounted trial / free trial offer?
YESNO
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