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. 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:
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.