Intuit Payment Solutions

Company Name: *

First Name: *

Last Name: *

Address 1: *

Address 2:

City: *

State:

ZIP Code: *

Phone: *

Who Should We Have Intuit Payment Solutions Contact First?: *

If you would like to have a sales representative call you directly, then select the first option. Otherwise, please select the alternative.

Email: *

Do you currently process credit cards?: *

If you have a current merchant account, please indicate this by selecting, "Yes".

Average Monthly Volume:

Please enter an estimate of what you will

Current Payroll Processor:

Current Version of Software:

Please indicate which version of software you are using or in the process of purchasing. If you are using more than one software (i.e. both QuickBooks Pro and QuickBooks Point-of-Sales), please indicate which one will be taking the credit card from your customer or client. A representative will make sure that the choice you have made reflect your needs. If you are not sure which one you need, please indicate this in the notes. If you have or will have multiple software types, please indicate this in the notes as well.

Type of Account Needed:

Please select which of these account types you are interested in. A representative will make sure that the choice you have made reflect your needs. If you are not sure which one you need, please indicate this in the notes. If you need multiple account types, please indicate this in the notes as well.

Notes:

Please let us know any additional information or concerns you might have. AT THIS POINT, YOU HAVE NOT AGREED TO ANYTHING AND NEITHER HAS INTUIT. THIS IS SIMPLY AN APPLICATION FOR A MERCHANT ACCOUNT.

Intuit Payment Solutions

QBS Remote Support