Online Application

For more information, or assistance with a credit card processing merchant account from American Merchant Systems, please fill out the inquiry form provided below and an AMS representative will contact you within 24 hours.
Email Contact: jackdaryanani@sprintmail.com

Products / Services

How were you referred to AMS: --------- Google Yahoo MSN Other other Products/Services you are seeking:     Credit Card Terminal Check Processing Terminal Internet Gateway Internet Virtual Terminal US Based Merchant Account Offshore Merchant Account 3rd Party Processing Check Guarantee ACH Processing Check Conversion ATM Machines

Business Information

Business Name:
Business Address:
City:	State: Zip:
Country:
Phone:	Fax:
Website:
Contact Name:
Email Address:

About Your Business

Are you a startup:	Yes No
Age of business:
Products/Services Sold:
How is your product/service sold:
Retail Storefront::	%
Mail Order::	%
Inbound Phone Sales:	%
Outbound Telemarketing:	%
Internet:	%
Total:	100%
Current Monthly Volume:	$
Projected Monthly Volume:	$
Average Credit Card Transaction:	$
Highest Credit Card Transaction:	$
Have you ever been terminated by a processor before? If YES, please explain in comments box below.
	Yes No
If so, by what banks/processors?
Who do you currently process with? (need last 3 months processing statements faxed to us: 702-898-5569
What banks/processors have you processed with in the past?
Why are you not with them anymore?
Who have you applied with so far?
How is the signers personal credit?	-------- Bad Fair Good Excellent
Credit Score:
Comments:
Enter the above text: