Online Application

Merchant Application for Payment Gateway Accounts

Sign up for a Merchant Account today through First Data Independent Sales.
A merchant account allows your business to accept credit cards!

Business Type
Business Name*
Last Name*
First Name*
Address 1
Address 2
City
U.S. State
ZIP/Postal Code
E-mail Address*
Day Telephone*
Evening Telephone
Preferred Contact Method	E-mail Phone
I'm interested in knowing more about:
How did you hear about FDIS?
Are you currently working with a FDIS representative? No Yes-please indicate representative

Amount you Process per year:	Under $250,000 Over $250,000
A First Data Independent Sales Representative will contact you shortly!

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©2005-2010 Cardservice International, LLC . All Rights Reserved. Privacy policy.
All trademarks, service marks and trade names referenced in this material are the property of their respective owners.
The First Data Independent Sales Agent Program is operated by Cardservice International, LLC.
Cardservice International LLC., doing business as First Data Independent Sales is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek,CA.American Express requires separate approval.