Merchant Services—Request for More Information

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To begin, please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process.

This form supports 256 bit SSL encryption, ensuring that no one else will see your personal information while it is in transit. Please view our Privacy Policy for more information.

Contact Info

  • OK Name of Business is required
  • OK Contact Person is required
  • OK Address is required
  • OK Address 2 is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Country is required
  • OK Contact Person is required
  • Phone

    - -
    OK Phone is required
  • Fax

    - -
    Optional OK Fax is required
  • Optional OK Email is required

Business Type


    Optional OK   is required
    Optional OK Yes we currently accept credit cards is required

Card Acceptance Environment

    Optional OK is required

When Contacting Me

  • OK Best Time is required
  • Optional OK Comments is required

Security Code

  • OK is required
  • First National Bank and Trust reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, I/we grant full permission to do so.

  • This document is being secured using SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and First National Bank and Trust.