Partner Programs - Moneris Application

• You'll get a phone call with three days to discuss pricing and program details. After you complete the necessary forms and return them, they'll be approved and you'll be ready to process with Moneris Solutions.
• You'll get a Credit Card Program Start-up Kit with all the forms you need to begin processing credit cards

To enroll in ASHI's Merchant Credit Card Processing Program, complete the information below and call, fax or e-mail to:

Moneris Solutions Merchant Sales - Ed Voss
Toll Free 866-423-8475
Fax 800-572-4322
E-mail ussales@moneris.com
Woodfield Corporate Center
150 N. Martingale Road, Suite 900
Schaumburg, IL 60173

Name:	*
Company:
Address:	*
City:	*
State/Province:	-- Please select -- Alabama Alaska Alberta Arizona Arkansas British Columbia California Canada Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Postal code:	*
Telephone:	*
Fax:
Email:	*
Do you currently process credit cards? *   YesNo If, yes who is your processor? How many locations do you process from? How much money do you process in VISA/MasterCard charges in a year?