Northwest Community Credit Union
Merchant Information Form
Date *
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Merchant Name *
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Merchant Primary Contact *
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Merchant Secondary Contact
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Merchant Street Address
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Merchant City, State Zip
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Merchant Phone Number *
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Merchant Email Address *
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Type of Business *
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Currently Accepts Credit Cards *
Existing Processor
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Monthly Sales Volume
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Credit Union Contact Name
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Credit Union Contact Email Address
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Branch Name or Location
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Credit Union Contact Phone Number
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I Am Interested in the Following Products *
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Additional Notes/Comments
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