Online Request Form
Type of Business:*
MAIL ORDER/TELEPHONE ORDER COMPANY
If OTHER Please Specify:
Credit, Debit, and Private Label Card Processing
Please fill out this section if you would like more information about processing credit, debit, or private label cards.
How will you process transactions?:
MANUALLY KEYED TRANSACTIONS
Are you currently processing credit, debit, or private label cards?:
Annual bankcard sales (or projected):
Average Ticket (or projected):
Do you want to accept online debit:
Do you need credit/debit/private label card equipment?:
YES. I WILL NEED TO PURCHASE/LEASE EQUIPMENT
NO. I HAVE EQUIPMENT TO REPROGRAM OR I HAVE AN INTERNET ACCOUNT WITH GATEWAY
Please enter model name and type of POS system/POS equipment or name of gateway:
Please fill out this section if you would like more information regarding Automated Teller Machines.
I am interestd in:
CARD/PAY PLACING AN ATM IN MY BUSINESS
PROCESSING WITH CARD/PAY WITH MY EXISITING ATM*
Enter make and model of ATM:
Please enter the text you see:
7110 SW Hazelfern Rd., Suite 260
Tigard, OR 97224
Card/Pay is a registered ISO of Wells Fargo Bank, N.A., Concord, CA.
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