Merchant Account Pre Application Form
Please complete our pre application form and one of our representatives will contact you with further information. 

Easy Qualification Process: 

  • You must operate a legitimate business located within the U.S.
  • Have a business checking account (or personal account for Sole Proprietors)
  • Must be 18 years of age or older
  • Not in a current open bankruptcy
  • Make sure your business type is not on our prohibited business list.
Services of interest: Retail - You already have a credit card terminal.
Retail - You need a credit card terminal.
Mail / Telephone / Catalog Order Processing
Fleet / Fuel Card Acceptance and Savings
Internet Payment Processing Virtual Terminal - Free Shopping Cart
Wireless Payment Acceptance 

Business Information:
(Required fields are in red.)

Legal Business Name:
"Doing Business As" Name:
Contact Person:  Mr. Ms. Mrs.
First Name:

Last Name:
Telephone Number:   Fax Number: 
Email Address:
Street Address :
Mailing Address (line2):
State , Zip Code
Web Site Address :
Tax ID:

Type Of Business: - select from the drop down menu.

Is this a? Sole Proprietorship,  Partnership,  Corporation,  LLC, or Non Profit

Products or Services Sold:
(Please be specific; e.g. shoes, shirts, active wear...)

Estimated Average Monthly Processing Volume: 
Average Ticket Size: 
Highest Ticket Size:  
(The most a customer will charge at one time)

Additional Comments or Questions You may Have

Businesses located in the United States only please.


It is a violation of our sites policy to use
our sites email address or contact form for SPAM or any other solicitation.

You can always fax this contact form to:

Avanti Merchant Services

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All Rights Reserved.