Merchant Setup Form

CLICK HERE to read Terms and Conditions.

Customer Information

Company Name


Street Address



Company Phone


Company fax


Contact Name


Contact E-Mail

Program Information

Select Program Type (select one):


Specific Program (select one program):


Monthly Pricing Structure (select one pricing program):
(Note - Overage on Levels 1 and 2 is 15 Cents per Transaction)


Processing Equipment:

Describe equipment (if applicable from above)


Processing Method:


Method of Payment for Startup Costs:

Please note that for ongoing monthly fees Gift Card USA will automatically ACH your business checking account on the first business day of each month. So that we have your correct checking account information please fax a blank voided business check to 215-489-7880 or email to support@giftcardusa.com. By submitting this form, I agree to the pricing set forth above that I have selected on this Merchant Setup Form as well as the Terms and Conditions.


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