Merchant Application Checklist

Retail Business
Additional Information for MOTO / Internet

Site Survey

Merchant Location:
Area Zoned
Square Footage
Is Inventory/Merchandise Consistent with Type of Business:
Are goods and services delivered at the time of sale:
I hereby verify that: (1) this application has been fully completed by the Merchant applicant; (2) if necessary, I have physically inspected the business premises of the merchant at the address above; and (3) the information stated herein is true and correct to the best of my knowledge and belief.

Terminal Input Request

Merchant Information


Equipment Information

Terminal Type:

Pin Pad Exchange $35.00:
Merchant Training:
(PABX Code)

Special Pricing

Special Pricing

Credit Card Information