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Merchant Services Inquiry Form

If you’re interested in contacting one of our seasoned client managers about a merchant account solution for your business, please complete the no obligation form below. We promise a timely response.

Corporate Business Name
Doing Business As or Trading Name
Geographic Location of Business
Address
Contact Person
Phone
Fax
Email
Company website URL
Alternate Phone
Title
Type of products or services you sell
Current Visa/MasterCard Processing Volume
Requested Monthly Credit Card $ volume (USD)
Average ticket/Sales Amount
Why are you seeking a new merchant account?
Have you ever had a merchant account relationship terminated?
Best Time to reach you (include time zone)
So that we may assign the correct Client Manager to contact you, what are your specific needs or questions?
How were you referred to EMS?
Product or Service you are interested in.

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