Merchant Account Online Application

Card Processing Systems provides two easy ways to apply, simply fill out the online form below or Click Here to print the application and fax it to us at (914) 472-9082. We're happy to help so please feel free to call us at (914) 472-9008 if you have any questions. Thank you.

 

MERCHANT INFORMATION (Section 1) * REQUIRED FIELDS
Business Legal Name*
---Is Your Business Seasonal? Yes No
Mailing/Billing Address*
City*
State*
Zip*
Phone*

Fax
Tax ID #*

Total # of Locations
   
Merchant *Doing Business As* Name*
Business Start Date*
How Long At This Location?
 
Location Address*(No P.O. Box)
City*
State*
Zip*
Phone*
Primary Merchant Contact
 
Email Address
Type of Ownership*
Please select an item.
Website*
American Express Merchant #
(If you want to use existing American Express Number)

 
OWNERS/OFFICERS (Section 2)* REQUIRED FIELDS
List the Two Owners with the Largest Share of Ownership
1. Name*
Title
Percentage of Ownership
%
Residence Address*
City*
State*
Zip*
Home Phone*
Social Security #*
   
Date of Birth*
State
   
 
2. Name
Title
Percentage of Ownership
%
Residence Address
City
State
Zip
Home Phone
Social Security #
   
Date of Birth
State
 
 
CREDIT INFORMATION (Section 3)* REQUIRED FIELDS
Annual Visa/Mastercard Volume*
Average Credit Card Ticket*

Total Sales*
 
BANK REFERENCES (Section 4)
Bank Name*
 
Transit Routing # (ABA #)*
 
Account Number*
 
Address*
City*
State*
Zip*
   

 
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Card Processing Systems is a registered ISO of Wells Fargo Bank, NA, Walnut Creek, CA