Accept Credit Cards

The information you provide will be used only to contact you about your request and to process your inquiry.

Business Name*

Type of products or services provided*

State*

Zip Code*

Contact Name*

Contact Phone*

Contact Email Address*

Comments

How Did You Hear About Us?*

Walk InMagazine AdInternetYellow PagesNewspaper AdReferralSales RepOther (specify below)

If other, please explain

If referred by a sales rep, which one?*

NoneLindsay PowellRon CochranGloria DingleSanders MurphyAnnie PowellPrince WatsonLeonard ChesterJohn YuMark ReynoldsAngela ClarkJane ShoemakerWendy AndeskiSteven DingleKay White

If the individual's name is not found above, Who Referred You to Us?

Business Questionnnaire

In order to properly evaluate and respond to your request for services, please provide a response to each of the following questions.

Does your business currently accept credit cards?

Yes No

Are you currently in need of credit card processing equipment?

Yes No Not Sure

How much do you currently accept, or anticipate accepting, in monthly charges?

Under $5,000/month?
$5,000 - $10,000/month?
$10,000 - $20,000/month?
$20,000 - $40,000/month?
$40,000 - $100,000/month?
Over $100,000/month?

What do you anticipate to be your average individual charge amount?

$1 - $50/transaction
$50 - $100/transaction
$100 - $1,000/transaction
$1,000 /transaction

What is your most likely method for accepting credit cards?

Manually swipe cards at a retail store or restaurant
Through a website or online business
By phone or through mail order
Manually swipt cards at mobile business/trade show
Other