Merchant Application
Please complete the form below to download the application.
Name:
Phone:
Email:
Currently Accept CC:
-please select-
Yes
No
Business Type:
-please select-
Convenience Store
Gas Station
Bar/Club
Grocery Store
Lodging
Retail Store
Office Building
Bank/Credit Union
School/University
Restaurant
Auto Repair
E-Commerce
Other
Majority of CC:
-please select-
In Person
Phone / Mail
Internet
Average Ticket:
-please select-
$1 - 19
$20 - 49
$50 - 199
$200 - 999
$1,000 - 4,999
$5,000+
Need Equipment:
-please select-
Yes
No
Monthly Volume:
-please select-
$1 - 999
$1000 - 4999
$5000 - 9999
$10000 - 24999
$25000 - 49999
$50000 - 99999
$100000 - 249999
$250000 - 499999
$500000+
Time Frame:
-please select-
ASAP
1-2 Months
2+ Months
1-800-396-5660 Option #0
1st National Merchant Services is a registered ISO/MSP of Wells Fargo Bank N.A., Walnut Creek, CA