Simply fill out this short application and
a representative will contact you shortly.

or Call: 1-800-446-1127

Applicant Information
First Name:
Last Name:
E-mail Address:
Business Name:
Address:
City, State, Zip
Country:
Business Phone:
Other Phone:
What are you selling?:
Web site (URL):
Do you have a merchant account now?	Yes No
Self-Rate Your Credit
How did you find us?
What Keywords did you use? (search engines)?
Referred by:	Merchant Services Dept.
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Registered Agent for:
Chase Merchant Services
and JP Morgan Chase Bank

MERCHANT SERVICES DEPT.
IPayment, Inc.

Offices in Scottsdale, Arizona and
Buffalo, New York

800 446-1127
(716) 630-0192
Fax: (801) 730-5978 or (480) 483-5435

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All Rights Reserved

Absolutely the Best Customer Service in the Business!

The application process is very simple.
Just fill out the short form and our representative will contact you shortly.
We will have you accepting credit cards in no time!!