Request for Credit Card Merchant Account

The following form will directly notify Intellisoft's preferred Merchant Account Provider of your interest in obtaining a credit card merchant account that integrates with the ManageMore Software and the IntelliCharge™ interface.  The Merchant Account Provider guarantees that you will not be charged any application fees, not be locked into any contract terms, and will be under no obligation to accept a credit card merchant account, if approved.

Please fill out this form as completely as possible. The Merchant Account Provider should contact you within 2 business days to get further information about your business model, credit amount desired, payment methods you want to accept, etc.


Owner's Name:  Mr.  Ms.  Dr.

First:     
 
Last:

Contact Name, If Different:

Business Name:

City: State:

 ZIP:

Best Phone Number To Reach Applicant: ( )     (REQUIRED)

Your Email Address:
(REQUIRED)

Your World Wide Web Address (If Applicable):

Please Feel Free to Send Any Comments You May Have.


For verification reasons, please type the following characters
in the space provided : Z8MM1                         (REQUIRED)