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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 Merchants Bankcard Systems of America in just a few days.

  merchant application photo  
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Location Legal Name

 
     
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Location D/B/A

 

Location #

 
 
     
 

Address (No P.O. Boxes)

 

Bldg./Suite #

 
 
     
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City

 

State

 

Zip

   
 
     
 

Phone #

 

Fax #

 

Customer Service Phone#

   
 
     
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Email Address

 
   
     
 

Website

 
 

www.

 
     
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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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© 2014 Merchants Bankcard Systems of America All Rights Reserved. If you would like more information Contact an Agent.

Merchants Bankcard Systems of America is a registered ISO/MSP of First National Bank of Omaha. American Express requires separate approval.