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Printable forms:
 

Instructions:

 1. Please fill out Merchant Application entirely. If you do not know the answer to a      question or a question is not applicable please leave blank.

 2. Print the application and sign and initial all appropriate places. In order to print the           application and the various other forms you may have to allow a pop-up window to      appear. Do so by clicking on the bar that appears at the top of the screen.

 3. Please fax application back to (631) 427-5012 along with a copy of a voided check.
 -   The voided check is so the routing and bank account # can be clearly read and      kept on file

 4. Also mail hardcopy of application and voided check to Universal Bancard Systems,      47 Cabriolet Lane, Melville, NY 11747.

 5. If you would like to accept American Express or Discovercard please download and      print each individual application and fill out by hand and fax/mail back along with your      merchant application.

 6. If you would like to accept Electronic Gift Cards or Electronic Check Service please      print out each appropriate application, fill out completely, sign and send back via      fax/mail to the address and number above.

 7. After completing the merchant application, you must go to the printable forms menu     on top and print out a copy of our ACH form and Purchase Order form. Please sign     both of these forms and mail/fax back along with signed applications.

Merchant Account Online Application

Personal information or e-mail addresses collected on our online application form are confidential and will be used only for the purpose of processing your application

MERCHANT APPLICATION
Date
Phone #
New Merchant
DBA Name
Corporate Name
Location Address
City
state
zip
Merchant Information
DBA Phone
DBA Fax
Corporate Address*
Corporate Phone*
Corporate Fax*
Fed Tax Id#
Website
Year Established*
Length Currently Owned
Business Structure
Closely Held Corporation
Publicly Traded Corporation
LLC
Sole Ownership
Partnership (General / Limited)
Sub Chapter S
Non-Profit
Services / Products Sold:
Ever processed / accepted CC:
If include your last 3 months statements
Cards to be accepted
Visa / MC
Amex
Discover
Pin / Debit
Other
Current Amex #
Current Visa/MC Processor
  

 

Choose an option that best describes your business

Internet
Retail
Mail/Phone Order
Wireless Mobile
Home Based

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