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     STEP ONE  
   
Legal Business Name:
Doing Business As:
Business Location:
City, State, Zip:
Country:
 
Business Form:
Federal Tax ID:
Business Phone:
Business Fax:
Email Address:
Website Address:
Transaction Type:
Describe Products:
Accepted Cards In Past:
Yes   No
Accept Cards Now: Yes   No
Processing Statements:
Business Start Date:
Average Sale Price:
Monthly Card Volume:
   
STEP TWO  Owner Information
   
Owners Name:
Home Address:
City, State, Zip :
Country:
Own Residence: OWN   RENT
Home Phone:
Cell Phone:
Best Phone:
Principal Title:
Ownership %:
Drivers License Number:
Social Security Number:
Date Of Birth:
Business Start Date: