Please fill out the following information and press the SUBMIT button

Business Information

Business Name
(doing business as)
Business Address
City
State
Zip
E-mail Address
Location Address
Location Phone
Location Fax
Corporate Name
(Use also for headquarter's
information)
Billing Address
(If different than location address)
City
State
Zip
Contact Name
Contact Phone
Contact E-Mail Address
Send Monthly
Statements to		 Corporate Headquarters Business Location
 
 
Type of Business
  Corporation Partnership Sole-Proprietorship
County and State of Incorporation
(in which Certificate of
Assumed Name)
Federal Tax ID Number
Detailed Explanation of Type of Merchandise, Product or Services Sold
 
Company History
Date Business Started
Length of Current
Ownership
Prior Bankruptcies? Yes No
If Yes:
Business and/or Personal
 
Owner/Partner/Officer
Name
Title
Home Address
City
State
Zip
Social Security
Phone
Driver's License
 
Card Services Currently In Use or Wanting to Accept
Visa/Master Card
Amercan Express
Discover
 
Sales
Gross Annual Sales
Average Ticket Amt
Hight Ticket Amt
 
Settlement Information
Depository Bank
Transit/ABA Number
Deposit Account Number

A hard copy of the merchant processing agreement and application (MPA) must be submitted in addition to this online preliminary application.
Select Banking Systems is a registered ISO/MSP of BancorpSouth Bank, Tupelo, MS American Express and Discover require separate approval. Privacy Policy.

A hard copy of the merchant processing agreement and application (MPA) must be submitted in addition to this online preliminary application.
 
Select Banking Systems is a registered ISO/MSP of BancorpSouth Bank, Tupelo, MS
American Express and Discover require separate approval.  Privacy Policy.