Business Information

Business Name *

Contact Name *

Email address *

Phone Number *

Business Website

Industry Type *

Current Processing Details

Do you currently accept credit cards?

Yes

No

Current Payment Processor

Current Processing Fees

Are You in a High-Risk Industry?

Yes

No

How Do You Accept Payments?

In-Person (POS/Terminal)

Online (eCommerce)

Mobile Payments (NFC, Tap-to-Pay)

Recurring Billing / Subscriptions

Invoice Payments

Other

Chargeback Rate %

0%
1-3%
4-6%
7% or more
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Current POS System or Terminal Used

Are You Interested in Equipment Leasing or Purchasing?

Yes

No

Transaction Details

Estimated Monthly Credit Card Processing Volume

Average Transaction Size

Total Monthly Transactions

Card Types You Accept (Select All That Apply)

Visa

Mastercard

American Express

Discover

Debit

EBT

Other

Percentage of Card-Present vs. Card-Not-Present Transactions?

100% In-Person / 0% Online
75% In-Person / 25% Online
50% In-Person / 50% Online
25% In-Person / 75% Online
0% In-Person / 100% Online
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Proposal Customization & Additional Needs

What’s Most Important to You?

Lower Processing Fees

Faster Deposits

Enhanced Fraud Prevention

Advanced Reporting & Analytics

Seamless Software Integration

24/7 Support

Interested in Additional Features?

AI-Powered Fraud Detection

Contactless Payment Solutions

Subscription Billing

Multi-Location Support

Custom Reporting & Insights

How Soon Are You Looking to Switch Processors?

ASAP
Within 1-3 Months
Just Exploring Options
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Best Time to Contact You?

Morning
Afternoon
Evening
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Any Additional Comments or Requirements?

Consent & Terms Agreement

“I agree to be contacted by Next Gen Merchant for a personalized merchant services proposal.”

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