Fill Out a Pre-Application – International Merchant Services

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Merchants

Fill Out a Pre-Application >

Fill Out a Pre-Application

Merchant

Company Name:
Doing Business As:
First Name :
Middle Name :
Last Name :
Company Address :
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone :
Cell Phone :
Home Phone :
Cell Phone :
Other Phone :
Fax :
Email
Website Address :
Please provide password if site is under construction or password protected:
Business Type :
About Business:
Country of incorporation:
New or Established Business:
Estimated Monthly Volume:
Average Ticket:
Average Ticket:
Highest Ticket:
Have you ever processed credit cards before?:
- Yes
- No
If you answered Yes above please indicate your current processor:
Reasons for requesting this account?:
- TMF (violation of merchant agreement or outstanding balance)
- Low Credit Score (less than 500)
- Capped Volume
- New Business
- High Chargebacks (Include monthly%)
How do you process or plan to process credit cards?:
- Retail
- Wireless
- Moto
- Internet
- Other (please specify)
Are you interested in:
- ACH
- Check Programs

International Merchant Services gene@officialims.com

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