FIELDS MARKED WITH * ARE REQUIRED!
YOUR
INFORMATION WILL NEVER BE SHARED, SOLD, OR GIVEN TO ANYONE!
Please note: Every application
goes through automated checks and manual screening. You
will receive notice of approval or rejection anywhere between
a few minutes and several working days.
Choose Your User Id:
(No Spaces or non-alphanumeric characters)*
Choose Your Password (5-16 Characters):*
Repeat Your Password:*
First Name:*
Last Name:*
Company Name:*
Company Address 1:*
Company Address 2:
City:*
State:*
Zip/Postal Code:*
Country:*
Phone:
You MUST supply your Company URL:* Please include "http://"
Help us check our progress - How did you find us?
Administrative E-mail Address: This address will
only receive password recovery messages and semi-annual membership probes.
This MUST be an administrative (webmaster, sales, admin,
etc.) address IN YOUR E-COMMERCE DOMAIN! THAT
MEANS ANADDRESS@YOURDOMAIN.COM This policy is STRICTLY enforced
for security reasons. Yahoo,
hotmail, Gmail, AOL, and all the others will be a waste of your time.
Administrative E-Mail Address:*
Add Url to Members list in the member area:
Yes
No
By submitting this form, you understand and agree to the following:
- That you have read the Privacy
Statement and that the information you provide will never
be used for any purpose other than the goals of Merchant 911.
- That you agree with and support the mission statement
of Merchant 911 as stated on this web site.
- That you will not reveal to any person or persons
outside your business, any passwords or other information received
from Merchant 911 in the members only areas.
- That if you elect to display any Merchant 911 emblem
on your site, you will do so only as required by Merchant 911.
|
