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Contact Name :
Business Name :
Phone (Daytime) :
Email :
Url :
Do you currently accept credit cards?
Yes
No
How would you most likely process?
-- Please Select --
Swipe cards at location
Wireless
Phone or Mail
Internet / Website
More than One Method
Do you need processing equipment?
Yes
No
Not Sure
Comment :
Robot Check :
Sum of 4 + 3 = ?
Complete this simple online form to apply for a Merchant Account.
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No Setup Fees
No Annual Fees
No Programming Fees
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