Merchant Accounts  
 

» Online Merchant Account Application

To get started, simply complete our no-cost Online Merchant Account Application. This option is for businesses based in the United States only.

Please fill out this form as completely as possible. However, if there is any information that you do not have available or any question you do not understand, simply leave that section blank and our staff will help you to obtain the missing information when we process your application. 

For your peace of mind, an Account Executive will contact you within 24 hours to verify the information you provide and to arrange delivery of our Welcome Package, including your Customer Processing Agreement. 

Owner's Name:  Mr.  Ms.  Dr.
First:      Middle Initial:      
Last:

Type of Ownership:
Sole Proprietor
Partnership
Corporation

Contact Name, If Different:

Legal Name of Business:

Doing Business as (DBA), If Applicable:

 
Please rate your credit on a scale from 1 to 10 with
1 being "Not so good" and 10 being "Excellent"

Location of Business
(No P.O. Boxes. If Home-Based, Enter Home Address):

Suite or Apartment # If Applicable

City: State:
 ZIP:

Country:
If Outside the USA, Please Enter Country Here:

If home address is the same as business address, click this box:

Home Address:

Suite or Apartment # If Applicable

City: State:  
ZIP:

Country:

Home Phone Number: ( )

Business Phone Number: ( )

Best Phone Number To Reach Applicant: ( )

Fax Number: ( )

Your Email Address:

Your World Wide Web Address (If Applicable):

Please enter approximate credit card sales. Your best estimate is fine.
Total sales should equal 100%.


Percent Retail (Credit Card is Present and Swiped) Sales: %

Percent Combined Phone and Mail Orders: %

Percent Internet Orders: %

Product or Service Sold:

Estimated Amount of Average Credit Card Sale: $

Estimated Monthly Credit Card Volume: $

Do You Currently Accept Visa, MasterCard, or American Express?
Yes
No

Which Credit Card Processing System Do You Want to Use?

Terminal with Printer
Terminal with Manual Imprinter
PC Software (Manual Processing / no Web Site)
Macintosh Software (Manual Processing / no Web Site)
Real-Time Processing / Virtual Terminal (Web based)

Do You Want to Buy or Lease the Processing System?
Buy
Lease

Comments.

 

To become a credit card merchant, click the submit button: 

Press only once and please wait for the confirmation page.
This may take up to 30 seconds.

Our Welcome Package Includes:

Our commitment to you in writing

All necessary paperwork to activate your account

Instructions for downloading software, if needed

Our 24 Hour Toll-Free Customer Support Line

Copyright© 2001 EMD Merchant Services, in association with MCCS, Inc. a registered ISO / MSP for the following FDIC-insured banks: Concord EFS, Paymentech, Chase Manhattan Bank, and Nova Information Services. All Rights Reserved.

» Company Info
About 

EMD Merchant Services

We are a trusted partner to business owners throughout the U.S., offering reliable and cost-effective POS cash management solutions including processing for all major credit and debit cards, as well as electronic check authorization.