Online Request Form - Bank card processing Portland OR

Online Request Form

Name:*

Email:*

Phone:*

Address:*

City:*

State:*

ZIP:*

Business Name:*

Type of Business:*

RETAIL
RESTAURANT
HOTEL/LODGING
INTERNET
MAIL ORDER/TELEPHONE ORDER COMPANY
OTHER*

If OTHER Please Specify:

Credit, Debit, and Private Label Card Processing

Please fill out this section if you would like more information about processing credit, debit, or private label cards.

How will you process transactions?:

SWIPED TRANSACTIONS
MANUALLY KEYED TRANSACTIONS
INTERNET

Are you currently processing credit, debit, or private label cards?:

YES
NO

Annual bankcard sales (or projected):

Average Ticket (or projected):

Do you want to accept online debit:

YES
NO

Do you need credit/debit/private label card equipment?:

YES. I WILL NEED TO PURCHASE/LEASE EQUIPMENT
NO. I HAVE EQUIPMENT TO REPROGRAM OR I HAVE AN INTERNET ACCOUNT WITH GATEWAY

Please enter model name and type of POS system/POS equipment or name of gateway:

ATMS

Please fill out this section if you would like more information regarding Automated Teller Machines.

I am interestd in:

CARD PAY PLACING AN ATM IN MY BUSINESS
LEASING/PURCHASING ATM
PROCESSING WITH CARD PAY WITH MY EXISITING ATM*

Enter make and model of ATM:

Please enter the text you see:

7110 SW Hazelfern Rd., Suite 260
Tigard, OR 97224

About Us
Associate List
Partnership
Support
Contact Us

Education
Technology
Compliance
Interchange Rates
FAQ

Card Pay is a registered Independent Sales Organization of Wells Fargo Bank, N.A., Concord, CA.
The Clover name and logo are owned by Clover Network, Inc. a wholly owned subsidiary of First Data corporation, and are registered or used in the U.S. and many foreign countries.

Go to Mobile website