Merchant Signup
Step 1 of 4
Customer Details
Tell us about the business and its processing profile.
Business Information
Platform(s) / Bank
*
Please Select
TSYS/Omaha - Citizens
Omaha - Merrick
North/Nashville/Bypass - Wells
Type of Ownership
*
Please Select
Sole Proprietor
Partnership
Corporation
LLC / LLP
Non-Profit
Legal Business Name
*
DBA
*
Corporate Phone Number
*
Corporate Email
*
Corporate Address
*
City
*
State
*
Please Select
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP Code
*
Physical Address Same as Corporate Address?
*
Please Select
Yes
No
Processing Volume
Description of Product Sold
*
Average Ticket
*
Typical High-End Ticket
*
Monthly Bank Card Volume
*
Rates and Fees
Pricing Structure
*
Please Select
Interchange Plus
Flat Rate/Fee
Cash Discount/Dual Pricing
True Surcharging
Rate %
*
Transaction Fee $
*
Monthly Service Fee $
*
PIN Debit / EBT
*
Please Select
Yes
No
% Card Swiped / EMV
*
% Keyed (Card Not Present)
*
Both percentages must equal 100.
Fields marked * are required
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