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Step One - Merchant Information
Do you want to accept Discover? (Free Setup)   Yes No
Do you want to accept American Express? (Free Setup)   Yes No
DBA (Doing Business As) Name (The DBA must match the name on your checking account where you would like your credit card sales deposited)  
Best Contact Phone Number  
Legal Name of Business  
Company Contact First Name  
Company Contact Last Name  
Title or Relationship  
E-mail Address  
Merchant Website URL  
Business Phone (e.g., 1112223333)  
Business Fax  
Business Address  
Business City  
Business State/Country  
Business Zip Code  
Step Two - Owner Information
Principal's First Name  
Principal's Last Name  
Date of Birth  (e.g., 01/01/1965)   / /
Home Phone  (e.g., 1112223333)  
Ownership %  
Home Address - If home address is the same as business address, click this box:  
Home City  
Home State/Country  
Home Zip Code  
Step Three - Business Information
Describe Products Sold (e.g., I sell toys)  
Business Ownership Type  
Home Business?   Yes No
Average Monthly Volume   $
Average Sale/Ticket Amount   $
Business Type  
Years or Months in Business  
Please, If You Remember, Where Did You Hear About Us?  
Please Feel Free to Send Us Any Comments You May Have.  

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