Interest Form – Williams Payment Solutions, LLC

Thank you for contacting Williams Payment Solutions, LLC, we appreciate your interest!
Someone will respond to your request as soon as possible.

Name of Business:

Business Address:

City:

State

Zip:

Business Phone:

Business Fax:

Business Email:

Business Website:

Ownership Type

If Other

Owner's Name:

Home Address (optional):

City:

State

Zip:

Description of services and/or products:

Currently accepting MC or Visa?
YesNo

Currently accepting American Express?
YesNo

Currently accepting Discover?
YesNo

Average Ticket:

Monthly Volume:

Seasonal Business
YesNo

If yes, list high volume months:

*This is not an application and additional documentation would be required to obtain a merchant processing account.