On-Premise Online Terminal & Payment Gateway System Install Form

Form name in the original page code: AssuredCredit On-Premise Online Terminal & Payment Gateway System Install 1999 ver 2.0

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

Select Current Financial Technology:

Select Technology Infrastructure

• Microsoft
• Linux
• Unix

Type of Purchase or Lease & Fee Plan Requested:

Select Purchase/Lease & Fee Plan

• Purchase & ASPConnect Monthly Fee
• Purchase & Fee Based Pricing
• Lease & ASPConnect Monthly Fee
• Lease & Fee Based Pricing

Estimated Monthly Volume:

Select Estimated Monthly Volume

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

Other – estimated monthly volume required

Estimated Budget (if not Leased & Fee Based):

Select Estimated Budget

• $10,000+
• $15,000+
• $25,000+
• other

Other – estimated budget required

Timeframe for Service Start:

Requested Timing for Active Service

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

Request Quote & Installbutton on the original form