| *Participation Level: |
* Fee notice: As explained in 2.2.2.4 of the Policy & Procedures document, Associates fees will be invoiced on a prorated basis.
|
| *User Name/Email: |
|
| *Confirm Email: |
|
| * Password: |
|
| * Confirm Password: |
|
| * First Name: |
|
| * Last Name: |
|
| Company Name: |
|
| * Street Address: |
|
| Street Address 2: |
|
| * City: |
|
| State/Province: |
|
| * ZIP/Postal Code: |
|
| * Country: |
|
| * Phone: |
|
| Are you a Payment Service Provider? [?] |
| |
|
| Does your company have an existing EMV implementation or plan one for the near future? |
| |
|
| * Characters Verification: |
|
| |
I have read and agreed to the Participation Agreement. |
| |
|