Secure Quick Books Credit Card
Payment Processing Form

Please complete our pre application form and one of our representatives will contact you for further information and to complete the sign up process. 

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.

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)

Please Provide Billing Payment Information to be used for Set Up Fee and Software License:

Name On Card:
Type of Card: Visa MasterCard
Card Number:
Expiration Date:
CVV2 (last 3 or 4 digit number on back of card where signature is):

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.