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Merchant Information Profile

Please tell us about your business so that we can give you an excellent processing proposal that best suits your type of business and needs. There is absolutely no obligation to sign up by completing this form. All information will be held in strict confidence. Kevin will contact you within 24 hours to discuss your processing options.


Contact Name
Business Name
Street Address
City
State Zip Code

Business Phone Number (please include area code)
Fax Number (if applicable)
Cell Phone(optional)
E-Mail Address
Website URL (www.-----.com)

Briefly what does your company sell or what services do you provide?

Which category does your business fall in:

Ownership:

My business is:

Are you currently accepting credit cards?


Reason for switching:


Estimate of monthly MasterCard & Visa dollar volume:


Approximate average ticket amount:

Comments:

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