Company Name:
Your Full Name:
Business Email Addr: (check for accuracy)
Business Phone:
Web Site (if applicable):
What is the best time to reach you?:
How did you hear about Gotmerchant.com?:
Your Total Requested Monthly Credit Card Volume $
Your Expected Average Credit Card transaction $
Your Expected Maximum Credit Card transaction $
Do you currently accept credit cards?:
How is the owner's personal credit?:
---------- Please Select One -------------
Below Average (< 500 Credit Score)
Average (500 - 600 Credit Score)
Good (600 - 700 Credit Score)
Excellent (700+ Credit Score)
Which product of ours did you want to use to process your charges?:
---------- Please Select One -------------
Retail Credit Card Machine
Free POS System
Free Cash Register
Free Nurit 8020
Smart Phone Swiper
Authorize.net Internet Gateway
Touch Tone (cell phone)
Yahoo Store
Other - Don't know
Please describe what you sell and include any questions you have:
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