Merchant Account

Allstate Merchant Services LLC.
132 West 36 Street, 3rd Fl.
New York, NY 10018

Mandatory *

Contact Name *

Field not valid (required or bad value)

Business Name *

Field not valid (required or bad value)

Phone Number * Please provide a valid phone number. 10 digits, numbers only.

Please provide a valid phone number. 10 digits, numbers only.

Best Time To Call Have a preferred time to be contacted? Tell us.

E-Mail Address *

Field not valid (required or bad value)

Referral Name If you were referred, please provide the name of the person.

City *

Field not valid (required or bad value)

State *

Field not valid (required or bad value)

Have you ever accepted credit cards? * Yes No

Field not valid (required or bad value)

•Years In Business This field is only required if you have accepted credit cards in the past.

•Monthly Processing Volume This field is only required if you have accepted credit cards in the past.

•Average Transaction

•Type of Business This field is only required if you have accepted credit cards in the past.

Upload a current Processing Statement If possible please upload a current Processing Statement. or fax it to 866 908 8472

Would you be interested in a selling your products online through our web solution program * Would you be interested in a website?

Would you be interested in a website?

If you spoke to an account manager, please specify his/her name. Please specify the name of the person you spoke with.

Please specify the name of the person you spoke with.