Meramak Bankcard Midwest Merchant Account Services

Merchant pre-application


Pre-Application / Contact Us Form or Call Toll Free 1-888-336-4872

Use the following form to pre-apply, contact us for a merchant account, or to simply ask us a question.


This form is for USA merchants only. We can only issue merchant accounts in the USA.

Just complete the no obligation form below for businesses located in the USA.
Click on Submit at the bottom of the page when ready to send.
Or if you prefer, call the number above toll free.
All information below is kept strictly confidential.

First, tell us who is completing this form:

Submitted By:
Email address:




Please fill out all remaining fields as best you can. If you do not know the answer to a question,
take your best guess and select the closest that would apply. If you do not currently accept credit cards,
please answer the questions as though you did.
Remember: You need to list a phone number for us to call you.
We sincerely appreciate your interest in our organization!

1. Which of the following is how you will receive credit card orders?
Retail Store (in person)
By Phone Order or Mail
Not Sure/Other

2. Which credit cards would you like to accept using a merchant account?
American Express
Diner's Club
Debit Cards

3. What would be the amount of your average credit card sale?

4. What is your current monthly credit card processing volume, or estimate?

5. How much do you expect your monthly processing volume to be in six months?

6. Which kind of credit card processing equipment and other services interest you?
Terminal with printer
Terminal without printer
Wireless terminal without printer
Wireless terminal with printer
Online processing-Real Time (customer enters own credit card number)
Online processing-Virtual Terminal (merchant enters credit card number)
Other (please specify): 

7. If you are looking for credit card processing terminals, how many do you need?

8. What is your buying timeframe?

Have you ever been placed on a TMF list? (Terminated Merchant File)

Describe the products and services you sell and
any additional requirements you may have.
Tell us the best time of day to call you, or if you prefer, you can call us.

Note: There is a 500 character limit for this answer.

Name of Business  Number of Employees
Owner's Name
Business Street Address
City    State   Zip
Business Telephone Number
Preferred phone number we can reach you at

It takes at least 15 seconds to process this form, after pressing submit.
Please wait a minute or two.








If you want to have a merchant account setup for you, call us or fill out our
pre-application and contact form online.