apply now - card processing inquiry form
business name (*)

Please type your full business name.
type of products sold and services provided (*)

please type the kind of products sold and services provided
full contact name (*)

Please type the contact person's name
street address (*)

please type your street address
Your Email (*)

Please let us know your email address.
city (*)

please type the city
state (*)

please type the state
zip code (*)

please type your zip code
email (*)

please type your email
cell phone (*)

please type your cell phone
which best describes your business? (*)

which best describes your business?
are you currently in need of credit processing equipment? (*)

are you currently in need of credit processing equipment?
How much do you currently accept or anticipate accepting in monthly charges? (*)

How much do you currently accept or anticipate accepting in monthly charges?
What do you anticipate to be your average individual charge amount? (*)

What do you anticipate to be your average individual charge amount?
What is your most likely method for accepting credit cards? (*)

What is your most likely method for accepting credit cards?
Does your business currently accept credit cards? (*)

Does your business currently accept credit cards?
Were you referred to imerchant direct? (*)

Were you referred to imerchant direct?
If so by whom? (*)

If so by whom?
comments (*)

Please let us know any additional comments.

  

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