U.S. Merchant Account Introductions Service

Secured Order Form

  

  
 

U.S. Merchant Account for non-U.S.-Reidents 

   Fees:
 

US Merchant Account
Accept Credit Card
Debit Card Payments
Outgoing Wire Transfers Debit Card Online
Online Virtual Terminal
Complete Internet Access
Manage your account from any where in the world

 
Please enter your total amount to confirm your fees:  

 

 

  

Step 1: Contact Information

  
   
Your name (first, middle, last):*  
Phone Number:*  
Your email address:*  
Reenter email address:*  

 
Address
 Street number & name
 Suite number
 ,
 City                                                  State / Province                           Zip
  
 Country
 
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Step 2: Entity

 
   

State of formation:

 

U.S. Entity:
Legal Name: *

 

Address: *

 

Describe your business activities*
Please be specific and provide a detailed description.

 
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Step 3: Authorize Signature / Officer

  
   

1. Name          
 First , Middle / Initials, Last 

 

2. Address


 Street number & name
 Suite number
 ,
 City                                                         State / Province                  Zip
 ,  
 Country  

  
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Step 4: Shareholders / Members

  
These are the individuals / other companies with ownership in your company.  
   

No.

Name

Address

ID# / Passport#

% of Ownership


1
.


2.


3.


4.

  Total % of Ownership     100%
 

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Step 5: Credit / debit card information:

 

 
1. Card:*   

 

2. Card Holder' Full Name:*  

3. Card Holder' Full Address:*( if different from entity)
  
 Street number & name
 Suite number

 ,
 City                                        State                        Zip 

  
Country 

4. Card Number:*    

 

5. Card Expiration Date:* MMYY    Verification Code   (Visa/MC 3 digits, AMEX 4 digits)

 

6. Your Initials* here to confirm the services checked above:

 

 

You can pay with your PayPal Account.
For Paypal Payment Instructions, please contact our Incorporation Specialist Online.

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Enter your Comments

  

 

  
Click here to submit your order:  

 

 

  

 

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