Card Service Professionals :: Sign Up Application

Complete the form below and submit your information to Card Service Professionals for review to accept credit card payments.

Legal Business Name *

DBA(s)

Mailing Address *

Years at this location

Years in business

Business Phone *

Fax Number

Other #

Contact Name *

eMail Address *

Website URL

Type of Company *

Max Monthly Volume *

Avg Ticket Amount *

High Ticket Amount *

Terminal/Equipment/Software currently being used (if any)

If leased or under lease what are the terms?

Principal's Name *

Principal's Title

How many years at current address? *

Terminal/Equipment/Software currently being used (if any)

Type of Phone Line

Add Mobile Terminal?

Yes

Accept American Express?

Yes

How did you hear about us?

Do you currently accept Pin-Debit Transactions

Is there an External Pin-Pad?

Describe or link to product return policy

Describe Product(s) or Service(s)

Number of Days until product is delivered

Upload your most recent monthly Merchant Statement if availableSelect File

Account Representative

Sign Up Application