COCARD® - For Him Processing - Credit Card and Merchant Services

Identify your business type.
Select which method of processing you prefer. Internet Processing: Virtual Terminal and Web Link - Automated on-line credit card processing a Authorize.Net. Credit Card Processing Software: PC or Mac - Perfect for merchants accepting credit card information via mail, telephone and fax. Point of Sale Terminal Equipment: Retail/Restaurant Special download programs available for Retail Storefronts, Restaurants, Hotels/Inns, and merchants processing government IMPAC or corporate purchasing cards.
Complete the Pre-Approval questionnaire below or call us at 888-778-2637 and let a representative guide you to achieving your goal of accepting credit cards!

OWNERSHIP:	Corporation Partnership Sole Proprietor Limited Liability Corporation Non-Profit
BUSINESS/CORPORATE NAME:
D.B.A.(Doing Business As)NAME:
LOCATION ADDRESS:
CITY:	STATE: ZIP:
BILLING ADDRESS: (If different from above)
CITY:	STATE: ZIP:
BUSINESS PHONE:	BUSINESS FAX:
CONTACT:
DATE BUSINESS OPENED:
EMAIL ADDRESS:
TIME ZONE:
FEDERAL TAX ID#:
BANK NAME:
ACCT#:	ROUTING#:

OWNER/OFFICER NAME:	TITLE:
HOME ADDRESS:
CITY:	STATE: ZIP:
HOME PHONE:
SS#:	DOB:
DRIVER LICENSE#:
STATE:	%OWNERSHIP:

AVERAGE CREDIT CARD TICKET: $	MONTHLY VOLUME: $
PRODUCT OR SERVICE SOLD:
WEB ADDRESS:

* Merchant authorizes Bank and or COCARD® to investigate their credit with the utilization of the Credit Bureau Reporting Agencies.