To fax us your application, please download the PDF application file from the link below and open using Adobe® Reader. Fax your completed application to (949)265-9053. The application is formatted with form fields so you can easily type in your information and print without writing on it manually.) You can download a free version of Adobe® Reader here... Please note: Due to limitations of a free version of Adobe Reader you will be able to PRINT application after you fill it out, but you won't be able to save it.

Click here to download PDF application... 



Simply contact our office directly at (800)662-8448 and an account representative will be able to answer any of your questions and help you apply for a merchant account. Or, you can fill in your contact information below, and a representative will contact you within 24 hours.

CONTACT FORM (This is not an application, a hard copy of the merchant agreement must be submitted to receive a merchant account.) Business Name Title Please Select Your Title... Mr. Ms. Mrs. Miss Dr. First Name Last Name Address 1 Address 2 City U.S. State Please Select Your State... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming ZIP/Postal Code E-Mail Address Day Telephone Evening Telephone Contact Method Call and Email Me Back Email Me Only Call Me Only How did you hear about National Merchant Center? or type in Name/Business who referred you to us... Are you currently working with a NMC agent or representative? No Yes, please indicate representative Any comments/questions? Input here... Verification Code Please: Hover your mouse cursor over a letter above if you can't read it.