Merchant account application

Merchant Accounts and Credit Card Processing Services

Merchant Application / Affiliate Application

* ALL BOLD FIELDS ARE REQUIRED.

Salutation:
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Your first name:
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Your last name:
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Company name:
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Your title:

Company email address:

Confirm this email address:
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Company phone number:
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Street address:
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City:
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State/Province:
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Zip/Postal code:
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Country:
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We regret that we cannot work with merchants in some countries.

Years in business:
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Do you have a web site:
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Web address:

Web address 2:

Web address 3:

Web address 4:

Web address 5:

Type of Website:

Description of business: We regret that we cannot work with merchants in some businesses.

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Average sale amount:
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Estimated monthly sales:
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Desired Currencies:

Are you currently processing:
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Current processor:

Can you provide past processing statements:

Please Rate Your Personal Credit:

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Please add four plus three: «

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All rights reserved.

Durango Merchant Services LLC is a registered service provider for the following FDIC-Insured Banks:

JP Morgan Chase Bank; BankcorpSouth Inc, Tupelo, MS;
US Bank of Minneapolis, Minneapolis MN.