FREE Processing Application
Sales Representative Name *
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COMPANY INFO
Business Name *
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Business Address *
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Mailing Address *
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Business Phone Number *
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Business Email *
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Business Website Address
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Type of Business *
Corporate Name (if Incorporated)
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Corporate Address (if different than above)
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Business Category *
Business Area *
Business Site *
Products/Services Sold *
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Years in Business *
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How would you like your statements to be delivered? *
PROCESSING INFO
Seasonal Merchant *
If Yes/Seasonal, which months are active?
Currently accept Visa and MasterCard? *
Equipment *
Following sum must = 100%
Card Swipe % (50% or greater preferred)
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Manual Keyed %
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Phone/Mail Order %
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Internet %
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Average Transaction $ Amount (Less than $350 preferably) *
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Highest Expected Transaction $ Amount? (Less than $2K preferably) *
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Monthly Credit Card Sales Volume $ (Level 1 & 2 = <$150K & $150K+) *
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Tax ID / EIN # # - # # # # # # #
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Primary Contact Name *
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Primary Contact Title *
Primary Contact % of Ownership (51%+) *
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Residence Address *
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Primary Contact Date of Birth *
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Special Requests/Comments
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