Please complete all fields, as best you can.
Enter your Merchant ID Number (MID) - or - Enter Need MID#	MID# = the number assigned to your business by your Merchant Bank.

Business Name:
First Name:
Last Name:
Address:
City, State, Zip:
Country:
U.S. Federal Tax EIN: (or Social Security #):
Telephone:	-
Best Time To Call:
Fax:	-
E-mail Address:	Required
Your Website URL Location: (If you have one)

Are You a New or Existing Business?	New Existing
Type of Business:
Business Location:
Nature of Business:
How Do You Market Your Business?:
What are your Plans for Real-Time Credit Card Processing?	Internet Commerce Store Front Both

Enter the Name of your Current Merchant Bank:	That's the bank that assigned you, your Merchant ID Number.
Estimate your Average Credit Card Transaction Amount:	What do you think the average size transaction amount will be during any one month.
Estimate your Maximum Credit Card Transaction Amount:	What do you think the largest transaction amount would be during any one month?
Estimate your Monthly Credit Card Volume:	The average combined total of all transactions during 1 months time.
Estimate the Amount of Card Transactions you are expecting to do per/month.	How many Credit Card Transactions do you think you'll be processing during one month?

Notes and/or Comments.
Remove this text before entering your message.

Once you have submitted this Pre-Application, you will be contacted - personally - by the Merchant Bank Rep and/or Payment Processing Rep with up to date pricing and guideline details. You are NOT obligated to purchase or utilize these ecommerce solutions however we have found them to be very, reliable.