AssuredCredit Merchant Gateway Application Form

Original form, shown read-only for the record. Grey boxes show each field's placeholder text; lists show every option.

Form name in the original page code: AssuredCredit Merchant Account Gateway Application Form 1999-2000

NOTICE: AssuredCard has been acquired by Milinx Business Group through CreditAssure Financial.^⁠[2] All merchant payment gateway services are part of the miCommerce Suite. Please contact a Milinx representative and upgrade to the new 300,000 concurrent users backend with high availability, enhanced security and global network access featuring Sun Microsystems, Oracle and Cisco.

Contact Firstname:

Firstname required

Contact Lastname:

Lastname required

Email Address:

Email Address required

Authorized Systems Admin Name:

Admin Name required

Do you have a Merchant or Terminal ID Number?:

Yes, No, Applied or other

• Yes
• No
• Applied
• other

Other - please provide public submission data only required

Projected Volume of Transactions:

Select Estimated Transaction Volume

• $50,000+
• $500,000+
• $5,000,000+
• other

Other amount required

Select Current Financial Technology:

Select Technology Infrastructure

• Microsoft
• Linux
• Unix

Timeframe for Service Start:

Requested Timing for Activated Service

• ASAP
• less than 30 days
• more than 90 days

Request Servicebutton on the original form