BASYS Processing Store Sign-Up Form

Customer Info

Customer First Name*

Customer Last Name*

Select CoreCommerce Plan*

DBA Company Name*

Customer Email Address*

Customer Phone Number*

What do you want the name of the store to be?*

Your store name will become your domain name, e.g. http://yourstorename.corecommerce.com/ Max 13 characters. You may not use symbols in your store's name.

Note: A password will be generated and provided when the store setup is complete

What will your store sell?*

Business Type*

Sales Rep Info

Sales Rep Name*

Sales Rep Company Name*

Sales Rep Email*

Sales Rep Phone*

Terms and Conditons*

I agree to the Terms and Conditions Below

View the terms and conditions

Card Info for Payment

This will be used as the card on file for the store going forward. The card is tokenized upon submission and is not stored anywhere in our platform.

Credit Card Number*

Name on Card*

Expires On:

Month*

Year*

Security Code*