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YOUR LOCAL U.S.A MERCHANT SERVICE PROVIDER FOR 20+ YEARS

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Thank you for letting us be your merchant service provider for your business

Business Tax ID EIN or TIN # *

Legal Business Name *

Legal Business Address *

Business Phone # *

DBA *

DBA Address *

Date Business Started

Average Ticket

Monthly Volume

Typical High Ticket

Type of Ownership: * Required

Sole Proprietor

Corporation

LLC / LLP

Which Solution will you be using? * Required

Mobile Solution

Cash Discount Program

Retail Terminal

Smart Terminal

Text to Pay

E-commerce

Do you currently Accept Payments?

Yes

No

Product / Service Sold *

Upload Merchant Statement

Upload File

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www.cardsmartchoice.com

1-866-767-2273

The Clover trademark and logo are owned by Clover Network, Inc., a FiServ Company. All other trademarks, service marks and trade names referenced in this material are the property of their respective owners.

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