Business owner accepting an electronic payment

Merchant Services Upload Statements

Contact Information

Contact Information

Business Name

Contact Person

Email Address

Phone Number

Business Information

Business Information

What products or services does your business sell?

Preferred Method of Acceptance

Mobile

Online

Point of Sale System

Software

Stand Alone Terminal

Virtual Terminal

Do you charge the customer prior to the delivery of the product/service?

Yes

No

Percentage of Payment Due

Number of days until receipt of product/service

Max File Size 15MB

In order to qualify for the free analysis and $100 gift card, I acknowledge that I have uploaded three (3) merchant services statements from within the past six calendar months. I understand for my business to qualify, it must have a principal place of business within the bank’s service area.

Max File Size 15MB

In order to qualify for the free analysis and $100 gift card, I acknowledge that I have uploaded three (3) merchant services statements from within the past six calendar months. I understand for my business to qualify, it must have a principal place of business within the bank’s service area.

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Jefferson Bank, a division of The Central Trust Bank. Member FDIC. Equal Housing Lender. NMLS #407985

© 2024

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Jefferson Bank, a division of The Central Trust Bank. Member FDIC. Equal Housing Lender. NMLS #407985

© 2024

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This icon indicates a link to third-party content. By clicking on the link, you will leave our website and enter a site not owned by the bank. The site you will enter may be less secure and may have a privacy statement that differs from the bank. The products and services offered on this third-party website are not provided or guaranteed by the bank.

Jefferson Bank, a division of The Central Trust Bank. Member FDIC. Equal Housing Lender. NMLS #407985

© 2024