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| Business Information |
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| Type of ownership: |
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| Industry:* |
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| What are the primary products / services that you sell?: |
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| How long have they been in business?: |
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| Are you a Registered ISO with MC and Visa?: |
Check to indicate "Yes" otherwise leave blank |
| Which Processor(s) do you currently use?: |
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| Which Clearing Bank(s) do you currently use?: |
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| Who are your Key Competitors?: |
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| In what geographic area do you operate?: |
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| What is your total Annual Revenue?: |
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| Total number of accounts in your portfolio: |
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| Annual MC/Visa Volume of Portfolio: |
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| What percentage of risk do you hold on portfolio?: |
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| Percent of Portfolio Card Swipe: |
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| Percent of Portfolio MOTO: |
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| Percent of Portfolio Ecommerce: |
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| Is your existing portfolio portable: |
Check to indicate "Yes" otherwise leave blank |
| How many Sales Reps do you have?: |
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| How many New Accounts do you expect to board with us per month?: |
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| Please describe why you feel our companies would be a good fit: |
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| Do you currently accept MasterCard / Visa?: |
Check to indicate "Yes" otherwise leave blank |
| Annual MasterCard / Visa Sales Volume: |
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| Merchant Partners services you want to resell |
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| Questions / Comments: |
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