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Merchant
Application
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Company
Name:
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First
Name:
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Last
Name:
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Business
Address:
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City:
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State:
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Zip
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Country:
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Phone:
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Phone
Alt:
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E-mail:
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Website
name:
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Type
of business:
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If
Internet Based Business
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If
Phone Order
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Are
you shipping a product:
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Yes
No
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Type of Merchant Account needed:
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Is
this a new business?
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Yes
No.
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How long has your company been doing business?
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How
is your personal credit? :
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Are
you a US based company?
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Yes
No
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To achieve a lower discount rate, can you provide a bank
reference?
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Yes
No
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To achieve a lower discount rate, can you provide 2 years
of personal or business tax returns?
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Yes
No
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To achieve a lower discount rate, can you provide company
financial statements
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Yes
No
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Present
Monthly Sales:
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Avg.
Ticket of Service or Product
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Questions/Comments:
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