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MES Partnership Application (MESP) - Business Information Business InformationEquipment SelectionPricing & Site ReviewApplication CompleteNavigation Help
Control #
Application Information Section help
Application Type * Referring Branch
Alt. Association
Referring Bank Bank Sales Rep  
Credit Approval Contact
Bank Rep
Rep Email Address
Business Information Section help
Names & Addresses
DBA Name *
Address Line 1 *
Address Line 2 *
City, State, Zip *
Country Code *
Federal Tax ID *
Mailing Name *
Address Line 1 *
Address Line 2 *
City, State, Zip *
Legal Name *
Phone Numbers, Contact Info & Email
Business Phone *
Business Fax *
Email *
Contact Name *
Contact Phone *
Customer Svc. Phone (if different from Bus. phone)
Business Description
Type *
Location *
Describe Business *
Please include types of goods & services sold
Industry *
Years at Location *
Date Est. (MM/YY) *
Chain/Non-chain * Number Locations *
Multi-Merchant Setups
Please complete these fields if this is a multi-merchant setup (Note: a separate app must be entered for each merchant that is part of a multi-merchant setup). Provide the total # of apps in this multi-merchant setup, which app # this is, the master DBA of the setup and the control # of the master app.
Total # Apps * App # * Master DBA * Master Control No. *
Transaction Information Section help
Estimated Sales Volumes
Monthly * Monthly V/MC * Avg. Ticket *
Annual * -- Annual V/MC * -- Annual Count * --
Refunds & Percentages
Refund Policy % Mail/Telephone/Internet Sales *
Seasonal Months
Peak Months *
Merchant History Section help
Ever Accepted Credit Cards Before? * No Yes If Yes, Previous Processor
Business Principals Section help
Primary Owner/Officer/Partner
Name *
Address *
City, State, Zip *
Phone *  
Soc. Sec. # *
Percent Ownership *
Gender *
Title *
Secondary Owner/Officer/Partner
Name *
Address *
City, State, Zip *
Phone *  
Soc. Sec. # *
Percent Ownership *
Title *
Business Checking for Deposits, Adjustments & Fees Section help
Please specify the merchant business checking account for deposits and fees. This information can be found on a copy of a check or on an account statement. Refer to the image above for tips on locating the checking account and transit routing number on a check.
Checking Acct. # *
Confirm Checking Acct. # *
Transit Routing # *
Confirm Transit Routing # *
Years Account Open *
Bank Name *
Bank Address *
City, State, Zip *
Payment Options Section help
Debit with Pin
  FCS #
Diners Club
  Diners Merchant #
  JCB Merchant #
American Express
MeS Direct Funding
Include Existing SE#
American Express Direct Funding
Existing SE#
Amex OptBlue
Amex Marketing Opt-In
  Discover Merchant #
    For new Discover account,
enter RAP discount rate
Valutec Gift Card
  Valutec Merchant #
    Valutec Terminal ID
Product Selection Section help
Merchant e-Solutions Payment Services
Point of Sale Terminal (Electronic Draft Capture)
MES Virtual Terminal Administrator Email
MES Payment Gateway Certified Name
  Must enter a certified name when selecting this option
  Processing Options
Card Present and/or Mail Order
e-Commerce, Card Not Present
  Administrator Email
Other Payment Services
Internet Solution Options
Website URL
  Administrator Email
Merchant has an existing Internet account
Tele Pay (Telephone Authorization & Capture)
Vital Third Party Software
  Must enter a certified name when selecting this option
Imprinter Plates (Ordered Without Imprinter)
Comments and Notes


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