Ecommerce Signup

Opening an ecommerce account is easy - this is a process that takes from 2 days to 2 weeks depending on the situation. Due to the time involved, we recommend that this be one of the things you do first in the course of helping with the takeoff of your project so that we are not waiting for this information upon completion. Please contact us if you have any questions about this process. Filling out the form below will enable us to process an application on your behalf for an ecommerce merchant account as well as an electronic funds processing account, which will allow you to accept payments electronically on and off your web site..

Privacy of Information
All information obtained by a|s during this signup is used solely for the purposes of opening and maintaining your new ecommerce account.  Simply put, a|s will not release, sell, or provide this information in any shape or form to anyone.

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Ecommerce Customer Information Sheet

Business Name:
Business Type   
   How long have you been in business?
Business Address:
Street
City ZIP
Country
Business Phone:
Owner #1
Information
Name
Date of Birth (mm/dd/yy)
S.S.N.    (Social Security Number)
D/L+State (Driver's License Number/State)
Home Add.
City    ZIP
Country  
Owner #2
Information
Name
Date of Birth (mm/dd/yy)
S.S.N.    (Social Security Number)
D/L+State (Driver's License Number/State)
Home Add.
City    ZIP
Country  
PRODUCTS or GOODS SOLD

Average Price of a sale:  (This is the average charge a customer might make on a credit card or a check.  Not the average item price, but the average total bill.)

Monthly volume of estimated credit card sales.

How will you advertise your business?

newspaper magazines mail outs internet flyers business cards fax
other

List 2 trade references for your business.  These may be any other business with which YOUR business will do or has done business. 

Reference #1

Company Name
Phone Number
Street Address
City ZIP
Contact Person 

Reference #2

Company Name
Phone Number
Street Address
City ZIP
Contact Person 

Do you have a refund policy?

If yes, please explain.

List the name and address of your Nearest Relative who DOES NOT LIVE WITH YOU.

Name Relationship
Phone Number
Street Address
City ZIP

List the name and phone number of your landlord.  (If you have one.)

Name Phone Number

 

PERSONAL CREDIT HISTORY

These questions are relative to the type of merchant account we will be able to offer you.  Please answer as truthfully as you can.  All answers are private and confidential.  WE CAN USUALLY APPROVE ANYONE!!! Please be honest up front.  This will speed up your approval process greatly.

Bankruptcy:  
Estimate your credit:


EQUIPMENT TYPE

I am interested in a    

Software/Internet (default)         

Credit Card Terminal

I have a specific product in mind that I wish to inquire about:

 

BUSINESS BANK ACCOUNT INFORMATION

This information is essential if you wish to receive the MONEY generated from your credit card sales!  Please be as accurate as possible.

Bank Name
Phone
Routing Number (9 digits on check next to account number)
Account Number