Concerned about your
privacy?
So are we. At this point we
only collect information
essential for understanding
you better  so we can point
you to the right services
package. Want to know more?
Visit our privacy policy.
This Merchant Account Questionnaire is your first step to accepting credit cards.
Our Account Manager will contact you shortly to finalize your application process.
All information provided to us will remain 100% confidential!
Apply free with no risk and obligation!
** New Merchant Account Questionnaire **
Merchant Information
Legal Business Name
Doing Business As
Business Street Address
City
State
Business ZIP Code
Business Telephone
Business Fax
Merchant E-Mail
Ownership Information
Type of Ownership
Owner 1 Name
Percent Owned
Owner 2 Name
(Leave Blank if Sole Owner)
Percent Owned
Contact Name
E-mail Address
Telephone
Business Information
Age of Business
Product, Service or
Merchandise Sold
% Face To Face (Swiped)
% Mail/Telephone Orders
% Internet Orders
Estimated Credit Card
Monthly Volume
Average Sales Amount
URL
Have You Ever Accepted
Credit Cards?
If Yes, Do You Currently
Accept Credit Cards?
Previous Processor
Merchant Account Setup
Merchant Account Type
Other Entitlements
(MC/Visa/Discover by default)
Core Product
(See Products)
Equipment Option
(Pricing Info)
Special Requests
Promo Codes
Comments
 
 
 
 
 
 
 
 
 
AMEX
 JCB
Diners
 EBT
ATM/Debit
 TeleCheck  (More Info)
Merchant Club (More Info)
The First Data Independent Sales Agent Program is operated by Cardservice International, Inc. Privacy Policy
Cardservice International, doing business as First Data Independent Sales (FDIS), is a registered ISO/MSP for Wells Fargo Bank, NA,
Walnut Creek, CA an FDIC insured bank. American Express® requires separate approval.
FDIS San Francisco is an independent agent office for Cardservice International.
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Attention New Merchants!
If you are a new Internet
merchant with estimated credit
card sales volume less than
$30,000/mo. please click here
to apply. No setup or
application fee for instant
approvals. Our standard pricing
will apply.
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