For questions about this form or about RDS Payment Services please call: 678.279.8038
To insure prompt service please fill in the form below as completely as possible.
First Name *
Last Name *
Company *
Email *
Phone Number *
City *
State * AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Other
Fax
Business Type * Restaurant Retail Grocery Personal Services Professional Services E-Commerce Lodging Subscription Services Entertainment Other
How do you receive payments? * In Person Mail Order/Telephone Order Via the Web
Comments *
Comments
Retail Data Systems is a registered ISO of Wells Fargo Bank, N.A., Concord, CA.
Data Systems Inc. is a Registered Agent of Citizens Bank, N.A., Providence RI