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MERCHANT ACCOUNT PRE-APPLICATION
(Note: Items in red are required)
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Please fill out the following information about your business and we will contact you within 24-hours:
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| Contact Name: |
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| Business Name: |
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| Business Address: |
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City:
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| State: |
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| ZIp Code: |
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| Business Phone: |
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| Fax: |
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| Mobile Phone: |
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| Best Time To Call: |
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| Web Site (If Any): |
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| E-Mail Address: |
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Please tell us about how you will be accepting credit cards:
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| Type of Merchant: |
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| Equipment / Software Needs: |
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| Average Ticket Size: |
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| Average Monthly Volume: |
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| Comments: |
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Please enter the code shown above: |
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