Merchant Application

Please fill out the following information in order for us to serve you better. Use the space provided below or e-mail us with any questions or comments you may have at IntegrationPartner@elavon.com . After reviewing your inquiry we will contact you immediately. We look forward to hearing from you.

Contact Name:* Company Name:* Business Type: Email:* Phone Number:* Phone Extension: Card Acceptance: VisaAmerican ExpressEBT
MasterCardDiscoverDebit
Annual Volume: Average Ticket: Mail Order, Telephone Order or Preauthorized Transactions: Merchant certifies that the total percentage of its transactions which are mail order, telephone order or preauthorized will be
0%
less than 10%
Over 10% (indicate approximate percentage)

Comment:*

Merchant Application

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