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First Name *
Last Name *
Business Name *
Phone *
Email
How are your products or services sold Select Customer 100% Face-to-Face w/customer Mostly Face-to-Face w/some phone orders Internet w/some phone orders Mostly phone orders Not Sure
Type of products or services sold
Approximately how much do you anticipate accepting in credit card sales each month? Select Amount $0 - $1000 per month $1000 - $2500 per month $2500 - $10,000 per month $10,000 - $25,000 $25,000 - $50,000 $50,000 - $100,000 per month Greater than $100,000 per month Not Sure
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Thank you for your application. We will review it and contact you shortly. Good luck!
