Customer (Merchant) Info

* Company Name

Please enter company name

* Street Address 1

Please enter street address 1

Street Address 2

* City

Please enter city

* 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

* ZIP

Please enter ZIP Please check ZIP

Company URL

Please check company URL

* Contact First Name

Please enter contact first name

* Contact Last Name

Please enter contact last name

* Phone

Please enter phone Please check phone

* Email

Please enter email Please check your email

Service Provider (Reseller) Info

* MagTek Customer Code (Confirm with MagTek Sales Rep if needed)

Please enter MagTek customer code

* Service Provider Email (This is where MPPG credentials are sent)

Please enter service provider email Please check service provider email

Processor Info

• American Express Brighton
• First Data Merchant Services (FDC) Nashville
• First Data Merchant Services (FDC) South
• First Data Merchant Services North (CardNet)
• Global Pay
• Global Payments East (NDC East)
• Global Payment Central (MAPP)
• Heartland
• Merchant e-Solutions
• Moneris
• NOVA (Elavon)
• Paymentech - Salem
• Paymentech - Tampa
• Paymentech iTerminal - Sale, Void and Refund only
• TSYS (Vital/VisaNet)
• Vantiv
• World Pay