Merchant Information Form
F&M BANK
Email address *
Date *
MM
/
DD
/
YYYY
Business Name
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Contact Name *
Your answer
Business Phone *
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Business Secondary Contact
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Business Street Address
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City, State Zip
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Currently Accept Credit Cards? *
Type of Business *
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Email Address
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Additional Comments/Notes *
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Existing Processor
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Monthly Sales Volume
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Bank Contact Name
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Bank Contact Email Address
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Branch Name or Location
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Bank Contact Phone Number
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Test *
Check All That Apply
Required
Additional Notes/Comments
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