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Retail Services
Face to Face Business

• 99% Approval
• No Application Fee
• No Set up Fee
• 1.69% Discount Rate
• $0.30 Per Transaction
• $10.00 Monthly Statement Fee
By Federal Law, All Information Provided Will Remain Confidential

Please fill out this form as completely as possible. However, if there is any information that you do not have available or any question you do not understand, simply leave that section blank, and our staff will help you to obtain the missing information when we process your application.

Remember that all of this information will be kept completely confidential. Charge-it-now.com FDIS will not share any of your contact information with anyone under any circumstances.

Please make sure that all names and addresses are spelled correctly. This is exactly how they will appear on your merchant account file.

You pay nothing until you are approved by First Data Independent Sales.


Business Information
Legal Business Name
DBA (Doing Busines As):
Type of Business:
Percentage Internet, Phone & Mail Orders:
Percentage Retail Card Swiped:
Average Sale Amount:
Average Monthly V/MC Sales Volume:
Business Phone:
Business Fax:
Busines Address:
City:
State:
ZIP:
Tax ID No:
Age of Business:
Web Address (URL):
Choose Equipment:
Owner's Information
Owner Name (First/Last):
Title:
Ownership Percentage:
Date of Birth:
Social Security Number:
Home Address:
City:
State:
ZIP:
Home Phone:
E-mail:
Bank Information (the bank account you would like us to wire your funds)
Bank Name:
Bank Account:
Routing Number:
Bank Phone:
Referral
Referred By:
Other:
   

 



© 1988- AI, Inc All Rights Reserved Privacy Policy
Services by Cardservice International
The FIRST DATA name, trademark and logo are owned by First Data Corporation. All other trademarks, service marks and trade names referenced in this material are the property of their respective owners. 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 of Wells Fargo Bank, N.A., Walnut Creek, CA.
American Express requires separate approval.
FDIS Agent #10102 is an independent agent for Cardservice International.
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