** HEARTLAND **
Submit Parameters
I am the customer
I am submitting on behalf of the customer
Processor Contact:

Required Site Info -->



Amex SE Number:

Your Name
  Submitter Name cannot be empty!
Customer Email (required)
   Invalid Email Address!
Submitter Email (required)

   Invalid Email Address!
Site Name
  Site Name required & must begin with a letter!
Country
Site Address
  Site Address cannot be empty!
City
  City cannot be empty!
State
Zip
  Zip is 5 digits!
  Zip is 6 characters!
Merchant # * 12 digits
  Merchant Number Must Be 12 digits!
Terminal # * 4 digits
  Terminal Number Must Be 4 digits!
Store # * 4 digits
  Store Number Must Be 4 digits (and not 0000)!
SIC * 4 digits
  SIC Must Be 4 digits!
Aquirer Bin * 6 digits
  Aquirer BIN Must Be 6 digits!
  Amex Tested OK
  Amex Test Failed: 
Info Here
Agent #(Agent Bank) * 6 digits
  Agent Bank Must Be 6 digits!
  Visa Tested OK
  Visa Test Failed: 
Info Here
Chain #(Agent Chain) * 6 digits
  Agent Chain Must Be 6 digits!
  Discover Tested OK
  Discover Test Failed: 
Info Here
Terminal ID * 8 digits
  Term ID Number Must Be 8 digits!
Processing...!
Time Zone/Industry    
Accepted Cards
Visa/MC      Discover         JCB
Amex          Diners       
 
Notes