Application

Start accepting credit cards at your business today.

General Business Information

Legal Business Name: *

Doing Business As

Tax ID

Please Select One:

Business Address: *

City:*

State:*

Zipcode:*

Business Phone Number: *

FAX#:

Date Business Started:

Description of Business:

Email Address: *

Total Annual Sales Volume:*

AVG Ticket $:*

Highest Ticket

Signer Information

First Name: *

Last Name: *

Title:

Ownership: (0-100%)

Home Address:

City:

State:

Zipcode:

Social Security #

DOB:

Home Phone #

Cell/Alternative #

Applicable Services (check all that apply)

Questions or CONCERNS

Please Upload Voided Check

Check "I'm Not A Robot" to Submit Application:*

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form

Universal Power Marketing, LLC, DBA Quantum Merchant Services is a registered ISO of Wells Fargo Bank, N.A. Concord, CA. American Express requires separate approval 1-800-815-3123 The Clover trademark and logo are owned by Clover Network, Inc., a First Data company. All other trademarks, service marks and trade names referenced in this material are the property of their respective owners. The Apple Logo, Apple Pay and iPad are registered trademarks of Apple Inc. © Google Inc. All rights reserved. Google and the Google Logo are registered trademarks of Google Inc. Micamp Solutions, LLC, doing business as Quantum Merchant Services, is a registered ISO of Wells Fargo Bank, N.A., Concord, CA.