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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