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Merchant Account Pre-Application


Please fill out the following brief application. We will contact you within 48 hours and let you know if you have qualified. This is a free service and there is no cost or obligation.

Sign up for a merchant account and get a free bonus.

Sorry, we do not accept gambling or pornographic activities.
BUSINESS INFORMATION
 Business Name: 
 Business Address: 
 City, State, Zip: 
 Country: 
 Area Code/Business Phone: 
 Business Fax: 
 Web Site Address: 
 Type of Business: 
 Business Start Date (MM/YY): 
Please describe products or services sold in a few sentences:
 Do you have a business license, certificate, or dba? Yes No
 Does the owner reside in the U.S. and have a SS#? Yes No
 Estimated Monthly Card Volume: 
 Estimated Average Card Sale: 
Order Sources? (must equal 100%)
Retail %
Mail/Phone Order %
Internet %
Trade Shows %
Other %
Please rate the owner's credit: 
CONTACT INFORMATION
 Contact Name: 
 E-mail Address: 
 Area Code/Phone number: 
 Best Time To Call: 
 Time Zone: 
 How did you find us? 
PROCESSING OPTIONS
Purchase or Lease?
Do you have a shopping cart software (online merchants)?
If yes, what is the name of the software?
Notes or Comments:

 

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Merchant Accounts:
 • Merchant Home      
 • Merchant Account
 • Free Accounts        
 • SPECIALS                
 

 

 

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