| Name
of Business: |
|
* |
| Contact Name: |
|
* |
| Title: |
|
* |
| Business Address: |
|
* |
| City: |
|
* |
| State: |
|
* Zip
Code:
* |
| Phone number: |
|
* |
| Email Address: |
|
* |
| Fax: |
|
|
 |
| Type of account: |
|
* |
|
Does your business currently
accept credit cards? |
|
Yes
No |
|
If Yes, what is the
name of the processor: |
|
|
|
Anticipated monthly
VISA/MasterCard volume (in dollars): |
|
* |
|
Anticipated average
credit card sale (in dollars): |
|
* |
|
| Comments: |
|
|
