Merchant Card Services
Merchant Card Services
Please fill out the form below and an Elevon representative will be in touch with you.
Name (First, Last)
Name (First, Last)
*
First
Last
Best Contact Phone #
Best Contact Phone #
*
-
###
-
###
####
Email Address
*
Legal Business Name
*
DBA Name (Optional)
Business Type
*
Airline Passenger Transport
Auto Fuel Dispenser
Car Rental
Convenience Purchase
Cruise Lines
Cash Advance
Direct Marketing
Internet/E-Commerce
High Risk
Hotel/Lodging
Other
Other Retail
Other Services
Purchasing Card
Restaurant
Retail
Warehouse Clubs
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
Estimated Annual Card Volume
*
$
Dollars
.
Cents
Current Merchant Acquirers/Processor (Optional)
E-Check Product (Optional)
E-Check Product (Optional)
Currently Offer
Interested
Not Interested
Gift Cards (Optional)
Gift Cards (Optional)
Currently Offer
Interested
Not Interested
Name of Valley State Bank Employee who referred you. (Optional)
Type the letters you see in the image below.