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About Your Business
Owners Name: Contact Name (If Different)
Company Name DBA (Doing Business As)
Address City State Zip Country Phone FaxOpen Date (month/Year) Product or Service You Sell
% of Sales by Mail Order % of Sales by Phone OrderAverage Sale Size: Estimated Monthly Sales Volume
Hours of Operation E-mail Contact AddressTax Id Number:
Best Number to contact youWhat Products Are You Applying For?
Credit Card Processing TeleCheck Gift Card Program Equipment Debit
Do You Currently Accept Credit Cards? (Y/N)
If So, Who Is Your Processor? Do You Know What Rates You Are Paying?
Is their anything you do not like about your current credit card processor?
What type of equipment are you interested in? Swipe Terminal PC Software On-Line Processing Do you lease or Buy Equipment? I tend to Lease I tend Buy I already own How soon would you like to get set-up?
Owner's Personal information
Home phone
How is your credit (Excellent, Average, Not So Great, Oops!) Have You Ever file For bankruptcy If so, what year?
Thank you for your time. You will be contacted within 24 hours with a proposal and a Rate designed especially for the unique needs of your business. Please take the time to visit WWW.TELACHECK.Com For other Business solutions. As usual, your business is greatly appreciated, as are any further comments that you may have.
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