Primary Contact Information

I. Business Information

Business Entity Type
Business Type*

Percent of Business

Must = 100%

Sales Method (Must = 100%)

II. Product Advertising, Sales & Delivery

What is your return, cancellation or refund policy?

IV. Processing Volumes

$
$
$
$

VII. Ownership

Must Reflect Ownership of 25% or More

Owner 1

Owner 2

Owner 3

Owner 4

VIII. Equipment Information

X. Rates & Fees

Pricing Structure

Discover Direct

American Express OptBlue

Other Rates & Fees

Gateway

Pin Based Debit

Lease Info

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