800-823-2131
 
 

Merchant Pre-Approval Form

(* indicates required field)
Name of Business
Contact Name  
Business Title  
Business Address  
Address 2
City  
U.S. State  
ZIP/Postal Code  
E-mail Address*   
Day Telephone*  
Business Fax  
Type of Best time of day to be contacted:
Preferred Contact Method Email Telephone
Type of Account
Does your business currently accept credit cards?: Yes No
If Yes, what is the name of the processor?:
Anticipated monthly Visa/MasterCard sales volume?
Anticipated average per sale amount (in dollars)?
Comments?
**By Federal Law, All Information Proveided Will Remain Confidential**

Please call 800-823-2131 if you have any questions.

  
   
     
   
             
             

Home | Merchant Solutions | Products & Services | About First Data Independent Sales

© 2006-2007 Cardservice International, Inc. All rights reserved. | Privacy Policy
The First Data Independent Sales Agent Program is operated by Cardservice International, Inc. 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 Agent #10138 is an independent agent office of Cardservice International. *Promotional offers brought to you by Cardservice of Goldcoast Inc. Restrictions apply. Call for details.