Merchant Account Application

Direct Contact Information
Fields marked with * are required. Complete the application form on this page. Be sure to complete as many fields as possible, as any blank fields may delay processing the application.
Contact Name *
Contact Telephone *
Contact Email *
Company Information
Legal Name
Tax Id
DBA
Owner
Address
City
Country
State/Province
Postal Code
Company URL
Product URL
Phone
Fax
Type of Business (Industry)
Years in business
European Company Information
European Director Information
Director Information
Name
Title
Email
Telephone Number
Address
Country
State/Province
Postal Code
SSN/SIN
Duration with Company
Additional Director Information
Processing Information
Current Monthly Volume $
Current Monthly Transaction #
Current Average Chargeback %
Estimated Monthly Volume $
Estimated Monthly Transactions #
Minimum Transaction Amount ($)
Maximum Transaction Amount ($)
Maximum Daily Amount ($)
Maximum Daily Transaction Count (#)
Maximum Monthly Amount ($)
Recurring Transactions	Yes No
Currency Type
Descriptor
Shop Location
PCI Certified	Yes No
Reference 1
Business Name
Contact Name
Contact Telephone
Reference 2
Business Name
Contact Name
Contact Telephone

M2 Systems Corporation
2301 Maitland Center Parkway
Suite 240
Maitland, Florida 32751
Tel: 407.551.1300
Fax: 407.551.1399

Direct Contact Information