Retex and Nationwide Payment Solutions have partnered to provide retailers an electronic payment processing solution that offers superior customer service and support, advanced technology, and a variety of value added services.

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Merchant Contact Information

Merchant Name (DBA):
Business Physical Address:
Business City / Town:
Business State, ZIP:
Service / Products:
Contact Person:
Business Phone:
Business Fax:
E-mail Address:

Business Profile

Business Structure:	Choose One Sole Ownership Partnership Corporation LLC
Merchant Type:	Choose Merchant Type Retail Restaurant Lodging Car Rental Other
Owner's Name:
Percentage of Ownership:	%
Does the Business currently accept credit cards?	Choose One Yes No
If "yes", for how long?	Years
Annual Credit Card Sales:	$
Percentage of Business done via Telephone, Mail Order or Internet:	%
Number of Locations that Accept Credit Cards:
Additional Comments:

Submit Information

Enter Security Code: