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| City |
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| State |
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| Zip |
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(Check all that apply)
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Credit and Debit Card Processing
Check Guarantee and Recovery
Gift and Loyalty Programs
Point of Sale Systems
Service and Support
Business Funding |
| SIC Code (if known) |
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| Year Established |
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| Average Card Sale |
$
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| Monthly Volume |
$
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| Card Present |
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| Card Present (Note swiped) |
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| Mail/Phone/Internet |
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| Are the services requested for a new or existing business? |
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| Type of Credit Card Processing |
Retail Using Stand Alone Terminal
Retail Using Integrated Cash Register
Internet e-Store Using Shopping Cart and Related Software
Mail/Phone Order Using PC Software
Mail/Phone Order Using Stand Alone Terminal
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| What type of business? |
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| Brief Description of Business |
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| If using a credit card terminal, please indicate the following: |
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Is there any additional information we should know when considering your application to accept credit card transactions?
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