Form to request a test account for purposes of testing credit card and other payment integrations to Sage ERP.

1. SAGE PAYMENT SOLUTIONS
1750 Old Meadow Rd, Suite 300
McLean, VA 22102
Telephone: 1-800-261-0240
Facsimile: (703) 848-9457
Virtual Terminal Test Account Request Form
Please complete the fields below with all of your business/contact information so we may create your
Virtual Terminal test account. You may fax the completed form to 703-991-5374 Attention: Virtual
Support or email it to virtualsupport@sagepayments.com.
Once the account is created, we will send the login information to the email address provided below. If
you have any questions about the Virtual Terminal or setting up the gateway integration you may
contact Virtual Terminal technical support at 877-470-4001 or virtualsupport@sagepayments.com.
**Please allow one business day for us to process your request.**
Request Date:
Type of Virtual Terminal Requested (Regular VT, VT3 or Donate Now):
Regular (SED)
Services Requested (Bankcard, Virtual Check, Shopping Cart, XML Web Services, and Vault):
Bankcard, Web Services
Would you like us to turn on Auto-Close (Yes or No):
Sales Office ID:
Sales Office/Rep. Name:
Sales Rep. Contact Phone # or Email:
Merchant Business Name:
Merchant Business Address (including city, state and zip code):
Merchant Contact Person:
Merchant Phone #:
Merchant Fax #:
Merchant Email: