Merchant Application Form

Ownership or Legal Entity Change

Yes No

Close Existing MID:

Close Date Existing MID:

Open Date:

Annual Volume:

Average Ticket:

Highest Ticket:

Add'l. Location

Yes No

1st Location MID:

Never Accepted Credit Cards

Yes No

Processor Change

Yes No

Card Present:

Card Not Present:

Card Swipe:

Imprint:

MOTO:

Internet:

B2B:

International Cards:

Type of Goods/Service Sold:

Refund Policy

No Refund Refund in 30 days or less
Merchandise exchange only Other

Seasonal Sales

Yes No

Active Months:

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