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Name

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Last Name

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Type Of Busniess & Name

Busniess Address (if you have one)

Address 1

Address 2

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State/Province

Zip/Postal Code

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How long have you been in business?

Are you currently accepting credit cards? (yes/no)

If you answered yes, who are you currently processing card payments with?

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How will you be processing transactions? (select all that apply)

Face To Face (in person )

Website

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Other

What is your estimated average one sale transaction amount?

What is your estimated business total monthly sales?

Best day/ time to contact you ?

Notes/Comments

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