ABOUT US FORMS & GUIDELINES AGENT SERVICES MERCHANT SERVICES CAREERS INVESTOR RELATIONS CONTACT US
AGENT SITE
M.A.D. SITE
 
Please fill out the following form to register as an Agent to represent the iPayment Cash Advance Funding Program. Although you are already an agent of iPayment or one of its affiliated companies, you will need to use your present Agent ID to register to represent the iPayment Program. You will receive an email with details of the program and useful links and tips on promoting the program.
AGENT INFORMATION
Your User ID Number: 4897
Company Name: *
Referred By:
Password: *
Payee Name: *
Contact Name: *
Title: *
Address: *
Address:
City: *
State: *
Zip: *
Phone: *
Fax: *
Please provide us with your correct email address, you will be receiving
your application confirmation as well as additional information.
Email: *
Email Verification: *
How did you hear about us? *
URL:

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iPayment, Inc. is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, CA
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