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Online Application

Thank you for your interest in applying for a merchant account with Modern Merchant Services.

This application should only take approximately 10 minutes to complete. Based on the information provided and business type, we may issue an Instant Approval and merchant number.

 

Please complete the following information. Fields in blue are required, fields in black are optional.
:: BUSINESS ADDRESSES

  BUSINESS DBA NAME:

DBA ADDRESS:
DBA CITY, STATE, ZIP:
DBA PHONE:
DBA CONTACT:
DBA FAX:

Click here if the legal information is the same as the DBA.
 BUSINESS LEGAL NAME:
LEGAL ADDRESS:
LEGAL CITY, STATE, ZIP:
LEGAL PHONE:
LEGAL CONTACT:
LEGAL FAX:

:: TAX INFORMATION & BACKGROUND INFORMATION
FEDERAL TAX ID:
EMAIL ADDRESS:
LOCATION TYPE: NEW LOCATION  
ADDITIONAL LOCATION
OWNERSHIP CHANGE
OWNERSHIP TYPE:
BUSINESS TYPE:
DESCRIPTION OF PRODUCT OR SERVICE SOLD:
YEARS IN BUSINESS:
YEARS CURRENT OWNERSHIP:
IS THIS A SEASONAL MERCHANT? YES     NO
DELIVERY OF PRODUCTS:
HAS THIS BUSINESS OR ANY PRINCIPAL BEEN TERMINATED AS A VISA/MASTERCARD MERCHANT (TMF)? YES     NO
HAS MERCHANT OR ANY PRINCIPAL FILED BANKRUPTCY OR BEEN SUBJECT TO INVOLUNTARY BANKRUPTCY? YES     NO
DOES THE MERCHANT CURRENTLY ACCEPT VISA/MASTERCARD? YES     NO
 IF YES, PLEASE PROVIDE THE NAME OF THE PREVIOUS PROCESSOR:
WHEN IS THE CARDHOLDER BILLED FOR PRODUCTS/SERVICES? ON ORDER     SHIPMENT
DOES THE BUSINESS USE ANY THIRD-PARTIES IN THE PAYMENT PROCESS? YES     NO
IF YES, PLEASE LIST:
WHAT IS YOUR REFUND POLICY?
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(c) Copyright 2007 Jacar Enterprises, LLC DBA Modern Merchant Solutions

United Bank Card is a registered ISO/MSP of First National Bank of Omaha, 1620 Dodge St., Omaha, NE - Member FDIC