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For more information please complete the form below or email:
sales@wisepaymentsystems.com
Alternatively, to contact us by phone please call
(800) 387-6458
.
Company Legal Name
*
Company DBA("Doing Business As") Name
First Name
*
Last Name
*
Title
CEO
President
Owner
Treasurer/Controller
Administrative Assistant
Business Manager
Business Development
Marketing Manager
Operations Manager
Office Manager
Consultant
Other
Email Address
*
Telephone
*
Fax
Address
City
*
State
*
Zip
*
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Web Address
Date Business Began
Is your Business currently accepting credit cards?
Yes
No
If yes, who is your current processor?
Paymentech
Bank of America
Chase Merchant Services
Nova
First Data / FDMS
NDC
Wells Fargo Merchant Services
Card Services International
PNC
Other
Please indicate which services are required: (check all that apply)
Visa
MasterCard
American Express
Discover Card
JCB
Check Conversion
Gift Cards
Store Loyalty Card
Point of Sale Terminal
Annual number of Visa/MasterCard transactions
0-75,000
75,001-150,000
150,001-300,000
300,001-450,000
450,001 or More
Current or Projected?
Current
Projected
Average Ticket/Sales Amount
$0-$25
$26-$50
$51-$75
$76-$100
$101-$125
$126 or More
Current or Projected?
Current
Projected
Tell us how you wish to process your transactions
Point-Of-Sale Terminal - New
Point-Of-Sale Terminal - Existing
VAR (For example, Micros, Squirrel)
PC-Based Software
Pay at Pump
Other...
Need Recommendation
If "Other" please explain
Please describe the Product(s) or Service(s) you sell
Comments
Are you an existing customer?
Yes
No
If so, please indicate your merchant ID #
Best Time to Call
Morning Phone
Day Phone
Evening Phone
Email
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Copyright © 2010, Wise Payment Systems, Inc. All rights reserved.
Registered ISO/MSP of First National Bank of Omaha, Omaha, NE