At Free Merchant Services We Care About Your Privacy!
All Information On This Page Is Secured By 128 bit SSL Certificate

United Bank Card and Free Merchant Services uses the same 128 bit encryption used by all major US banks.

Your are only one step away from getting your Merchant Account and your choice of a Free Nurit 8500x Terminal or a Free Nurit 8020 Wireless Terminal.

This is a no risk application for our free equipment offer! We have made this process as easy as we can and guarantee your satisfaction. No up front fees are required. No long term contracts to sign!

Please contact us if you have any questions - (808) 276-1538

To get started, please complete all fields below.
Then hit the “Submit Application” button.

Company Name	A value is required.
Primary Contact (Full Name)	A value is required.
Mailing Address (No P.O. Boxes Please)	A value is required.
City	A value is required.
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 Washington D.C. West Virginia Wisconsin Wyoming Please select an item.
Zip	A value is required.Invalid format.
Phone 1	Include Area Code.Include Area Code.
Phone 2 (optional)	Include Area Code.
Email Address	Invalid format.
Your Date of Birth	- Month - January February March April May June July August September October November December Please select an item. - Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Please select an item. - Year - 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Please select an item.
How Long Have you Been in Business?	A value is required.Invalid format.
Your SSN (No Dashes)	A value is required.Invalid format.
Federal Tax ID# or EIN (No Dashes)	A value is required.Invalid format. Help
Your Bank's Name	A value is required.
Checking Account # (No Dashes)	A value is required.Invalid format. Help
9 Digit Bank Routing # (No Dashes)	A value is required.Invalid format. Help
Trade Reference Name	A value is required. Help
Reference Phone # (No Dashes)	Include Area Code.Include Area Code.
Type of Ownership (Select Only One)	Sole prop     Partnership     Corp LLC              Non-Profit       Other
Business Type (Select Only One)	Retail        Restaurant    Lodging MO/TO      Internet         Other
Products/Services You Offer	A value is required.
Business Location	Retail    Residence     Internet
Average Charge Ticket	A value is required.Invalid format. Help
Average Monthly Volume	A value is required.Invalid format. Help
Highest Charge Ticket	A value is required.Invalid format. Help
What percent of your sales are conducted face-to-face?	A value is required.Invalid format. Help
Choose a Terminal	- Select One - Nurit 8500 Nurit 8020 Nurit 8320 Other Please select a terminal.
How Did You Find Us?	- Select One - Google Yahoo MSN Alta Vista AOL Lycos Dogpile Hotbot Excite Friend Associate Other Please let us know.
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