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Business Information


Enter today's date MM/DD/YY

Your EMAIL address (please be
sure this is correct)

Legal Business or Corporate
Name

Storefront/business address



City
State
Zip Code

Type of business (be specific)

Mail order%
Phone order%
Other non-mag%

Number of locations

Business age (years)

Date business acquired

Principal Contact Name

Title

Phone number

Monthly Bank Card Volume
($)(estimate)

Average estimate ticket ($)(estimate)


Type of Business : Sole ProprietorshipPartnershipCorporation


Does merchant currently have a merchant account?

Has merchant ever had a merchant account?








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© copyright 1997 Merchant Services Provided by G.A.De Roos, Independant Contractor Humboldt Bank, Eureka

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gad@compuserve.com