Merchant 911 Membership Application

FIELDS MARKED WITH * ARE REQUIRED!

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://"
Add Url to Members list in the member area:
Yes No

Help us check our progress - How did you find us?

Administrative E-mail Address: This address will receive password recovery messages and semi-annual membership probes.
It MUST be an address IN YOUR E-COMMERCE DOMAIN! 
This policy is STRICTLY enforced for security reasons.
Yahoo, hotmail, AOL, and all the others will cause your application to be rejected.
Administrative E-Mail Address:*


By submitting this form, you agree to the following:

  • That you have read and understand our Privacy Statement and Terms of Service and that information you provide will never be used for any purpose other than the goals of Merchant 911.
  • That membership includes double opt-in subscription to our Newsletter. Unsubscribing does not change membership status.
  • 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.