Merchant Request Form - Rate Comparison
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Business Owner/President
Legal Corporate Name &/or dba
Mailing Address
City
State Zip Code
State Zip CodePhone Fax
FaxEmail Website
WebsiteType of business
Contact Person Best time to call
Best time to callContact Person’s phoneExt
ExtNumber of terminals currently in use and how many accounts per terminal:
Equipment type or software you are currently using:
How do you primarily process your credit card transactions? (In % please)
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