I am interested in learning more about your merchant processing services

If you are not currently a NOVA customer, please provide the following information about your merchant processing needs so we may properly respond to your inquiry. Please note that this form does not constitute a contract for services and should not be used to transmit confidential information.

If you are currently a NOVA customer with an inquiry, please use our secure U.S. & Canada Customer Support Contact form.

*denotes required field

*Name of Business:

*Address:

*Address 2:

*City:

*State/Zip Code: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY  

*Country:

*Contact Person:

*Phone:

*Fax:

*Email Address:

*Confirm Email:

*My Time Zone:

•  Eastern Time
•  Central Time
•  Mountain Time
•  Pacific Time
•  Alaska Time
•  Hawaii Time

*Best Time to Contact Me:

•  Anytime
•  Morning
•  Afternoon
•  Evening
•  Weekend

Business Type

Retail	Mail/Phone Order	Internet
Home Based	Restaurant	Lodging
Other

Do you currently accept credit cards:  Yes No 

If yes, what is your current processing volume:

I am interested in (check all that apply):

Credit/Debit

Electronic Gift Card

Electronic Check Service

Dynamic Currency Conversion

Processing Equipment:

I Need

I Own

I Rent

I Lease

Not Applicable

Equipment Type/Model:

Payment Terminal

PC-based Payment Software

Value-added Reseller

Not Applicable

Current Processor:

Comments:

 

SUBMISSION OF THIS FORM IS A REQUEST FOR A NOVA REPRESENTATIVE TO CONTACT YOU.