Notice: Use this form only if you are an official iTransact Reseller, and only for exception situations in which iTransact.com is directly billing your client. If you have a standard Reseller billing arrangement (you bill your client; iTransact.com bills you), please click here. If you are not a Reseller and are setting up iTransact's services for your own use, please click here. All fields are required. Click the PROCESS AND CONTINUE button at the bottom of the form when completed. For questions, please call iTransact.com at (801) 298-1212.

1. RESELLER INFORMATION

Reseller CODE:

2. YOUR CLIENT'S GENERAL INFORMATION

Business Name: (If no business name, enter contact name.)
First Name:	Last Name:
Title:
Address:
City:	State: Zip:
Country:
Web Site URL:
Contact Phone Number:
Customer Service Phone:
Fax Number:

3. YOUR CLIENT'S EMAIL INFORMATION Click here for an explanation of each email address.

General Contact Email:
Email for Orders:
Email for Order Form Errors:

4. PASSWORD Please select a password for your client to use. It must be six to ten characters in length. Since this may be changed at any time by your client, you may enter a generic password. Please be sure to let your client know what password you have chosen.

Password:
Verify Password:

5. YOUR CLIENT'S BILLING INFORMATION
Billing Method:	Credit Card Check

CREDIT CARD INFORMATION

	Credit Card Number:
	Expiration Date:	01 02 03 04 05 06 07 08 09 10 11 12 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
	Address on Card Statement:
	Zip on Card Statement:

CHECKING ACCOUNT INFORMATION

THIS INFORMATION MUST BE FROM A CHECK, NOT FROM A DEPOSIT TICKET.
	Nine digit ABA number:
	Account number:

DO NOT PRESS STOP ONCE YOU HAVE SUBMITTED THIS FORM. INFORMATION IS PROCESSED IMMEDIATELY.