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Business name:
Trading name (if different):
Business address:
Telephone number:
Fax number:
Web site address:
What is your name?
Contact email address:
 
*After filling out the application you will be prompted for payment of $395.00. This payment will reflect the entire cost of your merchant account and your payment processing system. If for any reason your account is not approved, your payment will be immediately credited.

*Upon successful completion, we will send you the necessary documents via e-mail. All you need do is complete them and return them to us and you can
begin processing credit cards.

 


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INTERNET MEDIA SOLUTIONS
Merchant Services
Buffalo, New York
716-874-5667
FAX: 716-874-5677