Sales Automation

Please complete each field as carefully and completely as possible!

A wide range of payment options are as important as selling quality products or services. Our competitive low rates keep more money in your business, and our full range of services gives your customers the freedom to use their favorite cards.

You can now accept VISA, MasterCard, American Express, Discover, ATM cards and others from your customers with your own, bank-direct, merchant account. Start-ups welcome. Retail, Internet, Mail-order, phone orders and catalog sales.

Gain REAL Benefits by using Business Financial Services to accept all major credit cards, debit and ATM cards. PLUS....

1. Access to Capital when you need it
2. Affordable credit card terminals and software
3. No application fees
4. No site-inspection fees
5. No setup fees
6. Approval and set up within 3-days
Please answer the following questions in as much detail as possible.

Please use your correct and valid email address as this is how we contact you.
Your Email:
Verify Email:
10 characters max
Contact Name:
Company Name:
Company Address:
Suite:
City:
State:
Zip:
Country:
Business Phone:
Business Fax:
Toll Free Phone:
Website:
 
Merchandise/Service Sold:
 
Federal Tax ID or SSN:
 
Date your business was established:
 
Has this business or any associated principal been terminated as a: Visa/MasterCard merchant?
  Yes No
Have you, the merchant, or any associated principal disclosed filed bankruptcy or been subject to any voluntary bankruptcy?
  Yes No
   If yes, When? Please specify date)
Previous Owner:
 
Previous Owner Phone Number:
 
Do you currently accept credit cards?
  Yes No
Current/Previous Bank Card Processor:
 
Reason for leaving:
 
How will you accept cards?
 
Average ticket:  
High ticket:  
Average Monthy Volume:  
High Monthy Volume:  
Names, titles, and addresses of company officers
Officer Name:  
Title:  
Address:  
City:  
State:  
Zip:  
Phone:  
Business Phone:  
Email:  
Social Security Number:  
Credit History:  
Ownership:    %
Officer Name:  
Title:  
Address:  
City:  
State:  
Zip:  
Phone:  
Business Phone:  
Email:  
Social Security Number:  
Credit History:  
Ownership:    %
TRADE AND BANK REFERENCES
Contact Name:  
Company Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Contact Name:  
Company Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Contact Name:  
Company Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
BANK REFERENCES
Bank 1:  
Address:  
City:  
State:  
Zip:  
Phone:  
Contact Person:  
BANK REFERENCES
Bank 2:  
Address:  
City:  
State:  
Zip:  
Phone:  
Contact Person:  
GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE

I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I Authorize all trade references, bank, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.

PERSONAL GUARANTEE: If the credit customer is a corporation, then those signing or submitting this application, whether signing/submitting as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.

By submitting this form, I agree that I have read the terms and conditions stated above and agree to all these terms and conditions.

Details: