MERCHANT ACCOUNT INQUIRY

MERCHANT BUSINESS INFORMATION

LEGAL NAME:

DBA (doing business as):

ADDRESS:

CITY:

STATE:

ZIP / POSTAL CODE:

PHONE #:

FAX #:

WEBSITE URL (if applicable):

OWNER INFORMATION

TYPE OF OWNERSHIP:

FIRST NAME:

LAST NAME:

OWNERSHIP PERCENTAGE:

%

PHONE #:

EMAIL:

HOW WOULD YOU RATE YOUR CREDIT?

CREDIT CARD SALES INFORMATION

WHAT ARE YOU SELLING / LOOKING TO SELL:
(list your products (i.e. shoes) and/or services (i.e. hosting))

HOW DO YOU / WILL YOU RECEIVE MOST CREDIT CARD ORDERS?

WHICH CREDIT CARDS DO YOU / WOULD YOU LIKE TO ACCEPT?

WHAT DO YOU EXPECT TO BE / CURRENTLY IS YOUR AVERAGE CREDIT CARD SALE?

$

WHAT DO YOU EXPECT TO BE / CURRENTLY IS YOUR MONTHLY CREDIT CARD PROCESSING VOLUME?

$

HAVE YOU PROCESSED CREDIT CARDS IN THE PAST WITH A MERCHANT ACCOUNT?

ANY ADDITIONAL INFORMATION: