REGISTRATION FORM

 

 

We consider all Account Managers, ISA Relationship Managers, Affiliates and/or Trade Associations without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap; or any other legally protected status.

 

How Did You Hear About Us:

 

To make multiple selections, hold down the CTRL button while selecting.

 

 

Principal Contact Information

 
Position Applied For::
Company Name:
Contact Full Name:
Contact Address 1:
Contact Address 2:
City:
State: form Zip Code:
Business Phone:
Business Facsimile:
Alternate Number:
E-mail Address:
Date Of Birth:
Driver's License No.:
Driver's License State:
        Federal Tax #: Social Security No.
Position Time Desired:
 Full Time: Part Time:

 

form
Credit Card Payment Information (For ISO/ISA Partners)
Cardholder Full Name:
Cardholder Billing Address:
Cardholder City: Cardholder State: Cardholder Zip Code:
Credit Card Number: Exp Date: CVV2/ CID Number:
 
Checking Account Payment Information (For ISO/ISA Partners)
ABA/ Routing No: Checking Account No: Check No.:
Bank Name: Bank City: Bank State:
 
Credit Card Employment Information
Are you currently selling Visa/ MasterCard services for another bank or ISO?
 
   

Projected average number of applications per month to be submitted to GMS:

 

Employment Resume:
 
Terms, Conditions, and Signature
 

By signing below I further certify my understanding that 1) I may not represent any party or business entity products of Global,

using any business name than "Company Name" listed at the top of this website form; and 2) by signing the Site Inspection

Form for any merchant application, I am subject to criminal penalties for false certification that I personally conduct.

 

I also authorize Global to ACH my residuals into my bank account in the future and I will attach a voided check to the

Independent Agent Marketing Agreement. Please include a copy of your Driver's License and Social Security Card.
 
Print Name:
Referred By:
Reference I.D. Number:
Date:

form

 

 

 


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