Merchant Account Setup Request | Netz Web Solutions LLC

Credit Cards Merchant Setup Request

This application is for US businesses only! All fields marked with an * are required.

Business Information:
Legal Name Of Business*
DBA Name*

The legal name on your bank checking account (Business checking Account is required!)
Contact Name*
Contact Telephone*
Contact Fax*
Street Address*

No PO Box Allowed!
Country*
State*
City*
Zip Code*
Type Of Business*
(ex. I sell hats…)
Estimated Volume*

The average monthly MC/Visa volume
Average Ticket Amount*

Estimated average ticket/sales amount
Highest Estimated Ticket Amount*
Accept CC Type (Other than MasterCard & Visa)*
- American Express
- Discover
- Dinner Club
Select Setup Type*
- Live Gateway
- Local Terminal
- PC Software
- Telecharge
- Wireless Terminal
Current Site URL*
Ownership Information
Ownership Type*
Principal Legal Name*
Ownership %*
Home Telephone*
Street Address*

(No PO Box Allowed)
Country*
State*
City*

(No PO Box Allowed)
Zip Code*
Date Of Birth*
DD slash MM slash YYYY
Driver License State*
Driver License Number*
License Exp. Date*
DD slash MM slash YYYY
eMail Address*
CAPTCHA