CCTerminal - Low Cost Virtual Credit Card Terminal

Welcome Letter

Merchant Information Profile

Please tell us about your business so that we can give you a processing proposal to get you merchant status.
There is absolutely no obligation to sign up by completing this form.
All information will be held in strict confidence. We will contact you within 48 business hours to discuss your processing options.

Business Information:
Business DBA Name
Contact Name
Address
City
State Zip Code

Business Phone Number (please include area code)
Fax Number
Pager or VMB (optional)
E-Mail Address
Website URL (www.-----.com)

Briefly what does your company sell or what services do you provide?

Which category does your business fall in:

If other please explain:

A site visitation will be conducted for all new merchants in accordance with MasterCard and Visa Association rules.

Are you currently accepting credit cards?

If yes, please fax your last 2 MasterCard/Visa merchant statements to 215-489-7880

Reason for switching:

Estimate of monthly MasterCard/Visa dollar volume:

Approximate average ticket amount:

Ownership:
My business is:
My personal credit is: