Atlantic Merchant Services Store Sign-Up Form Customer InfoCustomer First Name* Customer Last Name* Select CoreCommerce Plan*Please SelectCoreCommerce ($29 per month)CoreCommerce Pro ($79 per month)CoreCommerce Business ($229 per month)CoreCommerce Enterprise (Contact us for Pricing)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 completeWhat will your store sell?*Please SelectAuto / IndustrialCrafts / GiftsElectronicsEntertainmentFashion / ApparelFood / DrinkHealth / BeautyHome decor / GardenJewelryMusicOtherSports / OutdoorsToys / Kids / BabyBusiness Type*Please SelectB2CB2BBothSales Rep InfoSales 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 conditionsCard Info for PaymentThis 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*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear*20202021202220232024202520262027Security Code*