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Currently Processing Credit Cards
* - Required fields have an asterisk.
1) Tell us what your company does:

2) Who are your current customers? (check all that apply)
General Public   Government   Business to Business  

3) How do you accept credit cards? (check all that apply)
Swiped via Terminal   Keyed via Terminal  
On-Line Gateway       E-Commerce (Shopping Cart)  

4) Type of Business that you are (check all that apply)
Retail   Restaurant   Mail/Telephone Order   Website/E-Commerce   Lodging/Car
Petroleum Supermarket   Non-Profit  

5) Average $ Sale Amount?

6) Average # of Transactions Monthly?

7) Average $ Processing Volume Monthly?

8) Seasonal Business?
Yes   No

9) Types of cards/payments you accept? (check all that apply)
Visa   MasterCard   Discover   AMEX
Gift Cards   Check Services   Pin-Based Debit  

10) Are there any technical challenges with your current equipment?

11) What do you like best about your current program?
12) * Company Name:
*Contact Name:
*Contact Phone:
*Contact E-mail:
Enter code as shown
in the image.
 



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