|
Please complete the merchant account pre-application
form below. A merchant service specialist will contact
you within 24 hours to answer your questions and
help you get started.
Or call us toll free
to apply by phone:
1-888-884-2447
|
|
| Your
Contact
Information |
| Your Name:
|
| Company Name:
|
| Email:
|
| Address:
|
| City:
State:
Zip:
|
| Website Address:
|
| Phone Number:
|
| Fax Number:
|
| Cell Phone Number:
|
| Best time to reach you:
|
| Preferred
Contact Method: |
|
email
telephone
cell phone
fax
postal
any |
| Does
your business currently accept credit cards? |
|
Yes
No |
| If
yes, what company currently handles your processing? |
|
|
| What
type of processing methods will you employ? |
|
|
| Type
of Products or Services you provide |
|
|
| Anticipated
Monthly Visa/Mastercard Volume |
|
Under $5,000/month |
|
$5,000 - $10,000/month |
|
$10,000 - 25,000/month |
|
$25,000 - 50,000/month |
|
$50,000 - $100,000/month |
|
$100,000+/month |
| Anticipated
Average Individual Sale |
|
|
| What
types of services do you currently use? |
|
|
| When
do you anticipate needing your merchant account? |
|
| Additional
Comments or Questions |
|
|
| If
you have a Promo Code, please enter it here: |
|
|
| Please
make sure you have filled out all fields before clicking
submit |
|
