SP_happy_icon.jpg welcome new savings fanatic!

Please fill out the enrollment form below as thoroughly as possible and call 877-829-7255 with any questions! Please note your information is handled securely and confidentially at all times.

*All the required fields must be completed in order to get you approved through underwriting for a merchant account.

Enrollment Wizard - Step 1 of 6

Owner Info

Physical Address

Business Info

Format mm/yy

Mailing Address

Additional Info

Bank Info

Equipment Information

Document Info

Terms & Conditions

By clicking "I Agree", I represent that I have read and am authorized to sign and submit this application for the above entity which agrees to be bound by the American Express® Card Acceptance Agreement (“Agreement”), and that all information provided herein is true, complete and accurate. I authorize CardConnect and American Express Travel Related Services Company, Inc. (“AXP”) and AXP’s agents and Affiliates to verify the information in this application and receive and exchange information about me personally, including by requesting reports from consumer reporting agencies, and disclose such information to their agent, subcon tractors, Affiliates and other parties for any purpose permitted by law. I authorize and direct CardConnect and AXP and AXP agents and Affiliates to inform me directly, or through the entity above, of reports about me that they have requested from consumer reporting agencies. Such information will include the name and address of the agency furnishing the report. I also authorize AXP to use the reports from consumer reporting agencies for marketing and administrative purposes. I am able to read and understand the English language. I understand that upon AXP’s approval of the Application, the entity will be the Agreement and materials welcoming it, either to AXP’s program for CardConnect to perform services for AXP or in AXP’s standard Card acceptance program, which has different servicing terms (e.g., different speeds of pay). I understand that if the entity does not qualify for the CardConnect servicing program, the entity may be enrolled in AXP’s standard Card acceptance program, and the entity may terminate the Agree ment. By accepting the American Express Card for the purchase of goods and/or services, or otherwise indicating its intention to be bound, the entity agrees to be bound by the Agreement.

You further acknowledge and agree that you will not use your merchant account and/or the Services for illegal transactions, for example, those prohibited by the Unlawful Internet Gambling Enforcement Act, 31 U.S.C. Section 5361 et seq, as may be amended from time to time, or processing and acceptance of transactions in certain jurisdictions pursuant to 31 CFR Part 500 et seq. and other laws enforced by the Office of Foreign Assets Control (OFAC). Client certifies, under penalties of perjury, that the federal taxpayer identification number and corresponding filing name provided herein are correct. Client agrees to all the terms of this Merchant Processing Application and Agreement. This -Merchant Processing Application and Agreement shall not take effect until Client has been approved and this Agreement has been accepted by CardConnect and Bank. Add following text under that section

PCI Compliance Notice

Merchants have 30 days after enrolling to update their PCI Compliance with TrustWave, our recognized provider for the service. They can reached by phone at 877­257­0239 or at https://pci.trustwave.com/cardconnect.


I Agree to the above terms and conditions


Owner Info

Physical Address

Business Info:

Mailing Address

Additional Info

Bank Info

Payment Information

Document Information

Terms & Conditions