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Electronic Merchant Application
 

Business Information 

 
 
W-9 Information
 
 
Banking Information
 
 
Owner Information

 
Equipment Information
 
Pricing Information
 
Account Information
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Upon submission this information will be used to apply for a merchant account with

Valued Merchant Services and/or one of our partners.

You will receive a copy of this application by email that requires electronic signature prior to approval. You may also receive requests by email for any supporting documentation required by underwriting.

Please email a voided business check or bank letter to applications@valuedmerchants.com prior to clicking submit below.

If you have questions about this submission, please contact us at

1-800-531-8575 x 0 or 1-208-569-4289 





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