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Merchant Financial Systems:

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Once you submit this Mini-Application
our office, a specially chosen member of our sales staff will call you back to complete your full merchant application in just a few minutes. The application must be signed by you before being submitted for approval.

You will be well on your way to a better level of service for your credit, debit, gift & loyalty programs and check processing. The Account Representative will be happy to answer all of your questions. You could be up and running with Merchant Financial Systems in just a few days.

Location Legal Name

Location D/B/A		Location #

Address (No P.O. Boxes)		Bldg./Suite #

City		State		Zip

Phone #		Fax #		Customer Service Phone#

Email Address

Website

www.

Contact Name

Multi Location Merchant?		Total Locations		Business Start Date		Date you took Ownership
No Yes

Business Structure

Sole Proprietor	Corp	LLC
Partnership	Non-Profit	Municipality

What percent of your customers do you see face to face?		Have you ever applied for a merchant processing account?
%		No Yes

Do you offer Warranties?		Do you offer Subscriptions?		Do you offer Memberships?
No Yes		No Yes		No Yes

Who is your current merchant processor?

Describe the Product or Service you are selling

Where do you conduct business?

Storefront	Industrial Building	Trade Show
Office Building	Residence	Other:

Business to Business Sales:		Direct to Consumers Sales		What is your Average Ticket:		Expected Annual Credit Card Sales:
%		%		$		$

Is this a Seasonal Merchant?		If Seasonal, dates of operation (month/day/year)
No Yes		Open Dates: Thru:

*Seasonal Merchants will be charged an annual fee in lieu of a monthly statement fee; all other monthly fees are charged year round.

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Merchant Financial Systems is a registered ISO/MSP.
American Express & Discover require separate approval.