Merchant Account Pre-App - Compu-Wise Texas Web Hosting, Web Design Texas, Search Engine Ranking

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Merchant Account Pre-Application (Secure Form, Confidential)
Please fill out the CONFIDENTIAL MERCHANT INFORMATION Pre-Application form below. Upon receipt of the information, we will contact you and completely clarify any additional questions you may have, including questions related to setup fees, discount rates, product investment costs, etc. You be the final judge. You shall then receive the final documents for your approval via overnight mail. Welcome to Cardservice International
Pre-Application
If you would rather not submit certain information over the Internet, please complete the form with as much information as possible, and we will contact you over the telephone to get the rest. Please double-check your telephone number.
Business Information
Legal name of business:
Contact:
DBA (doing business as):
Telephone Number:
Fax
Street address:
City:
County:
State:			ZIP:
Mailing address (if different than above)

Address:
City:
County:
State:	ZIP:
Type of business (be specific)
Federal tax ID # (if available):
Sales tax license # (if available):
Estimated average monthly MC/Visa volume:	$ (ex. 10,000.00)
Age of business:	years months
Estimated average ticket/sales amount:	$ (ex. 12.50)
Highest estimated ticket amount:	$ (ex. 500.00)
Current URL (if applicable):
Type of ownership:
Ownership Information
Principal's legal name:
Ownership %:
Home telephone:
Social Security number:
Driver's license number:
State:	Exp. date:
Home address:
City:
State:	ZIP:
How Long?	years months Own Rent
Date of birth:	mm/dd/yy
E-mail:
Previous address if less than 3 years.
Street Address:
City:
State:	ZIP:
How Long?	years months Own Rent
Current Processing
Current/previous processor (if applicable):
Current merchant numbers:	Amex
	Discover
	Diners
Comments or Questions?
Comments/Questions

Best time to call
Hardware/software area of interest	If other, please specify:
(may take a moment, please be patient)

Contact Us
Cardservice International Call Toll Free: (800) 634-7221 Direct Dial: (919) 510-9488 Fax: (919) 782-9489 E-mail: sales@expandyourbusiness.com 3701 National Drive Suite 204 Raleigh, NC 27612 © 2001 Cardservice International, Inc. All rights reserved. Privacy Policy.		Guaranteed approval satisfaction or 100% money back.
Cardservice International is a registered service provider for the following FDIC-insured banks: First Financial Bank, Atlanta, GA; Humboldt Bank, Eureka, CA; Redding Bank of Commerce, Redding, CA; Tehama Bank, Red Bluff, CA. Debit Sponsor: Carrollton Bank, Baltimore, MD. American Express and Discover require separate approval.