Sign Up – Gift Card USA

CUSTOMER INFORMATION

Company Name*

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Company Phone*

Company Fax*

Contact Name*

Contact Email*

PROGRAM INFORMATION

Select Program Type

Gift Card Program Only

Loyalty Card Program Only

Both Gift Card and Loyalty Card Programs

Specific Program (select only one)

Program A (Starter) - 100 Standard Cards for $199.00

Program B (Custom) - 250 Custom Cards for $300.00

Program B (Custom) - 500 Custom Cards for $400.00

Program B (Custom) - 1000 Custom Cards for $500.00

Program B (Custom) - 2500 Custom Cards for $1000.00

Program C (Gift and Loyalty) - 500 Gift & 1000 Loyalty for $900.00

Other - Please Call to Discuss

Processing Equipment

I already own compatible equipment - describe below

I need to buy a terminal from Gift Card USA - describe below

I plan to just use the Free Web Terminal

Describe equipment (if applicable from above)

Processing Method:

Dialup using a phone line

IP via the internet

Method of Payment for Startup Costs

Credit Card

Mail a Business Check

ACH from your Checking Account

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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Merchant Setup Form