Merchant Accounts and Credit Card Processing Services

 Merchant Application / Affiliate Application

* ALL BOLD FIELDS ARE REQUIRED. Salutation: Mr. Mrs. Ms. « Your first name: « Your last name: « Company name: « Your title:   Company email address: Confirm this email address: « Company phone number: « Street address: « City: « State/Province: « Zip/Postal code: « Country: United StatesCanadaUS Outlying IsVirgin Is (U.S.)AlbaniaAmerican SamoaAndorraAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBouvet IslandBrazilBr. Indian Ocean T.BruneiBurkina FasoBurundiCameroonCape VerdeCayman IsCentral African RepChadChileChristmas IslandCocos (Keeling) IsColombiaComorosCongoCongo, Democratic RepublicCook IsCosta RicaCote D'IvoireCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican Rep.EcuadorEl SalvadorEquatorial GuineaEritreaEthiopiaFalkland IsFaroe IsFijiFinlandFranceFrance (Metro)French GuianaFrench PolynesiaFrench Sou. Terr.GabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard & McDonaldVaticanHondurasHong KongHungaryIcelandIndiaIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, South (Republic)KuwaitKyrgyzstanLaosLesothoLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMaldivesMaliMaltaMarshall IsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova RepMonacoMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNeth AntillesNew CaledoniaNew ZealandNicaraguaNigerNiueNorfolk IslandNo. Mariana IsNorwayOmanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRwandaSt Kitts & NevisSt LuciaSt Vincent & Gren.SamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSeychellesSingaporeSlovakiaSloveniaSolomon IsSomaliaSouth AfricaS Georgia & Sand IsSpainSri LankaSt HelenaSt Pierre & MiquelonSudanSurinameSvalbard & J. MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTanzaniaTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IsTuvaluUgandaUnited Arab Emir.United KingdomUruguayUzbekistanVenezuelaVirgin Is (Br.)Wallis & Futuna IsWestern SaharaYemenZambia « We regret that we cannot work with merchants in some countries.     Years in business: « Do you have a web site: Yes No « Web address: Web address 2:   Web address 3:   Web address 4:   Web address 5:   Type of Website: products services gaming adult pharmaceutical other Description of business: We regret that we cannot work with merchants in some businesses. «   Average sale amount: « Estimated monthly sales: $0 - $1,000 $1,000 - $5,000 $5,000 - $10,000 $10,000 - $25,000 $25,000 - $50,000 $50,000 - $100,000 $100,000 - $200,000 $200,000 - $400,000 $400,000 - $600,000 $600,000 - $800,000 $800,000 - $1,000,000 $1,000,000 + « Desired Currencies:   Are you currently processing: Yes No « Current processor: Can you provide past processing statements: Yes No Please Rate Your Personal Credit: Poor Average Good Excellent Help us prevent spam, Please add four plus three: «

 

Include:

TRAVEL SERVICES
MULTI-CURRENCIES
HIGH AVERAGE TICKETS
CREDIT/DEBT COLLECTIONS
POOR CREDIT
ELECTRONICS
MAIL ORDER
TELEPHONE ORDER
HARD TO ACQUIRE
HIGH VOLUME
TIMESHARES
REAL ESTATE
HERBAL SUPPLEMENTS
FINANCIAL CONSULTING
TELEMARKETING
DATING WEBSITES
EBOOK DOWNLOADS
SOFTWARE DOWNLOADS
SEO SERVICES
EVENT TICKETS
PREPAID DEBIT CARDS
CALLING CARDS
VOIP SERVICES
TELECOMMUNICATIONS
MLM MARKETING
DIRECT SELLING
BUSINESS OPPORTUNITIES
FFL DEALERS
ANNUAL CONTRACTS
MAGAZINE SALES
VACATION RENTALS

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National Bankcard Systems is a Registered ISO/MSP of:
Wells Fargo Bank, N.A., Walnut Creek, CA | US Bank of Minneapolis
American Express may require separate approval.
ShaneK is an independant contractor for Harris N.A., Schaumburg, IL