MyUSMS.com

Credit card processing service and ecommerce online payment gateway, allowing you to access Visa and MasterCard with a credit card merchant account.

Please complete this merchant questionnaire for more information about our services.

First Name:
*

Last Name:
*

Business Name:

Address:

City:

State

Zip

Daytime Phone:
*

Evening Phone:
*

Other Phone:

What is the best way to contact you?

E-Mail Address:
*

Your Homepage URL:

Are You a New or Existing Business?
New Existing

Business Type:

Business Location:

Nature of Business:

How Do You Market Your Products or Services?

Describe Products Sold:

How Soon Do You Need To Start Accepting Credit Cards?

Are You Interested In Check Services?

Are you currently working with a U. S. Merchant Service Representative?
No Yes

If yes, which rep:

How do you hear about us?

Notes or Comments:

Please submit this form and you will be contacted by a New Account Specialist, ASAP!