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** Type of Payment Method:
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** Type of Account required:
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Name of Business:
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Contact Name:
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Contact Email:
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Business Address:
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State/Province
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Zip/Postal Code:
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Daytime Phone:
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Business Fax:
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Legal Name of Business:
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Principal Owner:
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Type of Product or Service Sold:
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Age of Business:
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** What credit cards do you currently accept ?:
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Who is your current processor:
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Indicate Monthly Visa and MasterCard volume:
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What is your average sales ticket:
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What is your website url:
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Which country are you incoporated in?:
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What percent is your monthly chargebacks?:
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** Direct or 3rd Party Account (new business):
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Comments:
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Type this :
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