Merchant Account Pre-Application


Thank you for your interest in NYS & SEO Services. Please fill out the pre-application below and a sales representative will contact you immediately. The following information is encrypted for your security and will be kept confidentially.

Legal name of business:
DBA name if different:
Type of Ownership:
Contact Name:
Company Physical address:
City: State : Zip Code:
Business Number :
Business fax number :
E-mail address:
Website Address (URL):
Owner home number:
Cell number:
Owner home address:
City: State : Zip Code:
CREDIT CARD SALES INFORMATION:
What products or services are you selling?
Estimate monthly credit card: volume
Estimate average sales ticket amount:
CREDIT CARD MACHINE OR WEBSITE
Do you need a credit card machine? yesno
Do you need processing software? yesno
Comment:
Comment/ Question: