This is a No Obligation
Qualification Form and is your first step to
accepting credit cards. By filling out this form you will "not
enter" in to any obligations or contracts
with
us. We will use it to determine the best program to offer you based on
the information you provide. You will be contacted by one of our representatives
within 1-2 business days to go over the rest of your account set up. Our
certified staff will teach you to walk, talk and learn the merchant processing
industry lingo. Not only will you know you're merchant program, you'll
get that "pampered" feeling with our helpful staff..
Note:
All Information Provided To Us Will Remain 100% Confidential
And
Not
Sold To Anyone !!
IMPORTANT:
The banks will
only approve your application if you meet the following requirements.
Please do not apply if you cannot meet the following requirements at this
time.
You must be a US citizen,
at least 18 years of age or have a US federal tax ID and not currently
going through a bankruptcy. If you had a past bankruptcy and it is charged
off we can still get you approved.
Your business must be
located in the US and you must have a physical street address. If you have
a Non-U.S. based business please check out our international program here:
Non US Merchant Accounts
Express
Pre-Application
Business
Information
Owner's
Name:
Contact
Name: If
Different:
Legal
Name of Business:
Doing
Business as name (DBA):
Business
Street Address: (Not
PO Box):
City: State: ZIP:Country:
Business
Phone Number:
FAX
Number:
Date
The Business Opened (Month/Day/Year):
Product
or Service Sold:
Percent
Mail Order:
Percent
Internet Orders:
Amount
of Average Sales Ticket:
Estimated
Monthly Sales Volume:
Your
Daily Business Hours:
Your
Email Address:
WWW
Site Address (If
Applicable):
Best
Phone Number To Reach Applicant:
Do
You Currently Accept Credit Cards ?
Yes No
Who
is your current provider and what is the reason for you leaving?
How
Did You Hear About Us? *
Note: This has to be filled in for the form to work.
Which
particular search engine
brought you here and what search term
did you use to find us? Example: Infoseek
- searching for merchant accounts.
What
Kind Of Equipment Do You Want To Process Your Credit Card Orders
?
Terminal PC
Software Macintosh
Software Realtime
Online Processing
Do
You Want To Lease Or Buy The Equipment?
Lease Buy I
already own a terminal I
already own software
How Soon Do You Want
to Be Set Up?
Overall What Did You
Think Of Our Site?
What Info Didn't We Provide
That You Wish we Did?
Owners
Information
Home
Address:
City: State: ZIP: Country:
Home
Phone Number:
Please
Self Rate Your Credit.
Excellent Fair Poor Previous
Bankruptcy. Year?
Feel
Free to tell us what you thought about our site.
We
really appreciate all the feedback we can get. If
you have any additional comments or questions please enter them here. We
really appreciate the time you took and the feedback we get. We'd also
like to know how you liked our site?
Press
the Submit Button
American Express and Discover card
require separate approval processes. There is no extra charge for the American
express application.
The application
fee cannot be waived if you already own equipment or software or a terminal
that you will use with this account.
Special high
risk merchants may require special rates not listed.
Note: Services
are only available to U.S. Based merchants.
