Here at Concord we always try to mak things simple. All we require is that you fax us a little bit of information about your company and your products.

Once you're approved, you have an online merchant account that's ready to go, access to our payment gateway technology.

For more information or to begin the registration process, please fill out this form or contact one of our representatives.

	Personal Information Last Name: First Name: E-mail address: Phone number: Fax number: (optional) Company Information Company Name: Domain Name: Street Address: (optional) Suite/Floor/Apt: (optional) City: State/Province: Zip: Country: United States of America Canada France Great Britain Deutschland Espana Italia Belgique Luxembourg Brasil China Japan Other Current Area of Business: (optional)
	Thank you for giving us this brief information about yourself. We will treat this information in total confidentiality. By clicking the button below and submitting this form, you agree that the information that you will receive is proprietary and confidential, and that you agree not to share or distribute this information with others.