** GLOBAL PAYMENTS **
** MERCURY PAYMENT SYSTEMS **

CREDIT CARD
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 and 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 # * Variable
Merchant Number Must not Be Empty!
  Gift Tested OK
  Gift Test Failed: 
Info Here
  Settlement Tested OK
  Settlement Failed: 
Info Here
Bank # * 6 digits
Bank Number Must Be 6 digits!
  Amex Tested OK
  Amex Test Failed: 
Info Here
  Visa Tested OK
  Visa Test Failed: 
Info Here
  Discover Tested OK
  Discover Test Failed: 
Info Here
Time Zone
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Accepted Cards
Visa/MC      Discover        JCB
Amex         Diners            GIFT
Notes