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* ALL BOLD FIELDS ARE REQUIRED. Salutation: Mr. Mrs. Ms. «   Your first name: «   Your last name: «   Company name: «   Your title:   Company email address:   Confirm this email address: «   Company phone number: «   Street address: «   City: «   State/Province: «   Zip/Postal code: «   Country: United StatesCanadaUS Outlying IsVirgin Is (U.S.)AlbaniaAmerican SamoaAndorraAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBouvet IslandBrazilBr. Indian Ocean T.BruneiBurkina FasoBurundiCameroonCape VerdeCayman IsCentral African RepChadChileChristmas IslandCocos (Keeling) IsColombiaComorosCongoCongo, Democratic RepublicCook IsCosta RicaCote D'IvoireCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican Rep.EcuadorEl SalvadorEquatorial GuineaEritreaEthiopiaFalkland IsFaroe IsFijiFinlandFranceFrance (Metro)French GuianaFrench PolynesiaFrench Sou. Terr.GabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard & McDonaldVaticanHondurasHong KongHungaryIcelandIndiaIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, South (Republic)KuwaitKyrgyzstanLaosLesothoLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMaldivesMaliMaltaMarshall IsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova RepMonacoMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNeth AntillesNew CaledoniaNew ZealandNicaraguaNigerNiueNorfolk IslandNo. Mariana IsNorwayOmanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRwandaSt Kitts & NevisSt LuciaSt Vincent & Gren.SamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSeychellesSingaporeSlovakiaSloveniaSolomon IsSomaliaSouth AfricaS Georgia & Sand IsSpainSri LankaSt HelenaSt Pierre & MiquelonSudanSurinameSvalbard & J. MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTanzaniaTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IsTuvaluUgandaUnited Arab Emir.United KingdomUruguayUzbekistanVenezuelaVirgin Is (Br.)Wallis & Futuna IsWestern SaharaYemenZambia «   View List of Prohibited Countries.     Years in business: «   Do you have a web site: Yes No «   Web address:   Web address 2:   Web address 3:   Web address 4:   Web address 5:   Type of Website: products services gaming adult pharmaceutical other   Description of business: View List of Prohibited Businesses. «   Average sale amount: «   Estimated monthly sales: $0 - $1,000 $1,000 - $5,000 $5,000 - $10,000 $10,000 - $25,000 $25,000 - $50,000 $50,000 - $100,000 $100,000 - $200,000 $200,000 - $400,000 $400,000 - $600,000 $600,000 - $800,000 $800,000 - $1,000,000 $1,000,000 + «   Desired Currencies:   Are you currently processing: Yes No «   Current processor:   Can you provide past processing statements: Yes No   Please Rate Your Personal Credit: Poor Average Good Excellent   Help us prevent spam, Please add four plus three: «

 

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Durango Merchant Services, LLC. is a registered ISO/MSP for:
Wells Fargo Bank, N.A., Walnut Creek, CA
American Express requires separate approval.
ShaneK is an independent contractor for BMO Harris Bank N.A., Schaumburg, IL
Durango Merchant Services TM

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