Account
Maintenance Request
Fax Completed Request to 1-800-344-3495
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Merchant Name: ________________________________________________________ |
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Merchant Number: ______________________________________________________ |
q Address Change
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Previous Address |
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_______________________________________________________________________ |
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Street Unit/Suite |
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_______________________________________________________________________ |
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City State Zip Code |
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New Physical Address (cannot be a PO box) |
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_______________________________________________________________________ |
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Street Unit/Suite |
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_______________________________________________________________________ |
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City State Zip Code |
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New Mailing Address |
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_______________________________________________________________________ |
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Street Unit/Suite |
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_______________________________________________________________________ |
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City State Zip Code |
q Phone/Fax Change
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Business Phone: (__ __ __) __ __ __ - __ __ __ __ Contact: ______________________ |
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Business Fax: (__ __ __) __ __ __ - __ __ __ __ |
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Other: (__ __ __) __ __ __ - __ __ __ __ Please specify: _________________ |
q DBA Name Change
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NOTE: This is the name that appears on a customer’s credit card statement. It should match the signage of your business, as well as the receipt.
Previous DBA Name: ____________________________________________________ |
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New DBA Name: _______________________________________________________ |
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X___________________________________________________ Date: _____________ |
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NOTE: Account Maintenance Requests will not be completed until all information is verified. Thank your for your cooperation. |