Merchant Lead Form
Are you a merchant, or are you with a bank?
If you are associated with a bank, what is your bank's name?
Who is the contact at the bank?
If you are associated with a merchant,
what bank do you use primarily for day-to-day business deposits?
More Business Information
Type of goods/services sold:
Primary Contact Person:
How long have you operated this business?
Do you currently accept VISA and MasterCard?
Are your sales primarily:
over the Internet?
Are your customers primarily:
Do you currenty own or lease credit card equipment?