Application for Accepting Credit Cards

Please provide the following contact information

*Name  
*Business Name  
*Street Address  
*City  
*State/Province  
*Zip/Postal Code  
*Work Phone    
*E-Mail Address  
*Service Provided

Additional information:

Are you currently processing credit card transactions? Yes No
Do you need a Credit Card Terminal or Internet Processing? Terminal Internet Processing Software
Please rate your credit on a scale from 1 to 10? (10 being perfect) 
What is the legal type of your business?
Would you rather buyout or lease your terminal?  Buyout  Lease
Is there any additional information we should know when considering your application to accept credit card transactions?