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QUESTIONS? WE HAVE THE ANSWERS
Please complete the following form and our Account Manager will call you within 24-hours with instructions on how to open a merchant account and purchase credit card processing equipment for my business.
1. CONTACT INFORMATION (* Required)
First Name
*
Last Name
Business Name
Business Address
City
State
Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone
XXX-XXX-XXXX *
Email Address
Website Address
2. BUSINESS DESCRIPTION
Type of Business
Apparel Banking Biotechnology Chemicals Communications Construction Consulting Education Electronics Energy Engineering Entertainment Environmental Finance Food & Beverage Government Healthcare Hospitality Insurance Machinery Manufacturing Media Not For Profit Other Recreation Retail Shipping Technology Telecommunications Transportation Utilities
Your Average Ticket Size
Average Ticket Size $100 or Less $100 - $500 $500 - $750 $750 - $1000 $1000 or More
Monthly Credit Card Volume
Monthly Credit Card Volume Less than $5,000 Volume $5,000 - $10,000 Volume $10,000 - $25,000 Volume $25,000 - $50,000 Volume $50,000 - $100,000 Volume $100,000 & More Volume
Description of Products/Services
3. COMMENTS OR QUESTIONS
Comments or Questions?(Tell us about your business)
© 2005 Powered by 2C Processor USA, LLC. • All Rights Reserved.Toll Free (903) 291-0888 • Office (903) 291-0888 • Fax (903) 758-64922C Processor USA, LLC. is a Registered MSP/ISO In Association with Bank Of America