Online Signup - Texas Business Development Center

FREE EMV CREDIT & DEBIT CARD TERMINAL SIGNUP

Choose from a Retail, Mobile Smartphone Swiper*, Internet or Virtual Terminal

Use Save & Return feature below if you want to start the signup and then return later with your previous work already saved, just create a login with a user name and password.

Save & Return

Save your progress and complete this form later. (optional)

BUSINESS AND OWNER INFORMATION

Simply fill out the fields below and then click the submit button at bottom of page

Company or Business LEGAL Name *

Phone Number for Your Business *

Cell or Mobile Phone Number

Type of Credit Card Terminal Requested 🛈

Type of Account Your interested In? 🛈

Email for Your Business 🛈

Contact Name(s) or Your Full Name

Type of Business Structure 🛈

Date Business Started +

Ownership % 🛈

FEDERAL TAX ID (EIN)

Web Site Address

Business DBA Address or PO BOX

Business LEGAL Physical Address (If different from DBA address)

Business Address City

Business Address State

ZIP CODE

Own or Rent your Biz Space 🛈

If Rent, Your Landlords Name 🛈

Describe Your Business Products / Services 🛈

% of Sales Made Where?
Must Total 100%

	Store Front/Swiped
	Internet Orders
	Mail + Phone Orders
	Keyed - Face to Face

0/100 points

Current Processor Name

Do You Get Statements? 🛈

Monthly Gross Sales 🛈

Monthly Credit Card Sales 🛈

Largest Sale Amount 🛈

Average Sale Amount 🛈

Owners Full Name (First, Middle and Last)

Date of Birth +

Owners Home Address

Home Phone

Home Address City

Home Address Zip

Home Address State

Social Security Number (SSN)

Drivers License Number

Drivers License State

Bank Name

Bank Phone

Bank Account Routing Number

Your Bank Account Number

Comments or Message

Your Signature - Click and Use Your Mouse to Sign 🛈

clear

Upload Files | Copy of Your Voided Check to Deposit Monies

OR - Simply use your Smartphone to take a picture of your Voided Check and email to: docs@911Texas.com

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