Discounted Credit Card Processing - Complete Credit Card Merchant Account
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Merchant Account Pre-Application...
No Cost or Obligation to submit "Pre-Application"

Please complete the following pre-application.  We will contact you as soon as possible to answer any questions that you may have.  This "Pre-Application" is a Free Service, and there is No Cost or Obligation.  Please complete this information as accurately as possible.  

Please note: At this time, we do not accept non-US based businesses.
 

General Information
Business Name:
Address:
City, St, Zip: ,   
Contact Name:
E-Mail Address:
Business Telephone:
Business Fax:
Type of Business:
Date Business Established: Month / Year:  (MM/YY) 
Product or Service Sold:
Web Site Address: www.
Business Location:
Est. Monthly Card Volume: $
Est. Average Card Sale: $
Order Sources:
(These must all add up to 100%)		 % Retail (Swiped)
% Mail/Telephone
% Internet
% Other:
Do you currently accept credit cards? No Yes. 
If Yes, Name of processor: 
  
Processing Options
Processing Option 
that you are interested
in:		 PC Software
Online Virtual Terminal & RealTime Link
Point of Sale Terminal w/ Printer
Other
I have my own equipment
Purchase
or 
Lease?		 I am interested in PURCHASING the above option
I am interested in LEASING the above option
I am unsure at this time
What cards
would you 
like to Accept?		 MasterCard & Visa
AmEx
Discover
Other
CheckMAN Would you like a FREE copy of CheckMAN software?  You will need to
place an initial check order to register your copy.
$25.00 Standard $0 + $20 for 300 Checks + ($5 s/h)
$60.00 Pro Upgrade $40 + $15 for 300 checks + ($5 s/h)
$0.00 I DO NOT wish to use CheckMAN
Ownership Information:
First Name:
Last Name:
Title:
Ownership %:
Please Rate
Your Credit:
History: Has business or associated principal been previously terminated as a Visa/MC Merchant?
No Yes
Other...
How did you hear about us?
Comments 
and / or
Best Time
To Contact: