Company Information

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 Please Tell Us About Your Business

---------------------------Select---------------------------- Retail Store Home-Based Business Mail or Phone Order Business Wirless Business / Onsite Processing Internet Business/Shopping Cart Flea Market Restaurant Grocery Store Convenience Store Mall or Kiosk Financial Institution Other

---------------------------Select---------------------------- Accepting Credit Cards for the 1st Time Existing Merchant

 Credit Card Processing Needs

---------------------------Select---------------------------- $100 or Less $100 - $500 $500 - $750 $750 - $1000 $1000 or More

---------------------------Select---------------------------- Less than $5,000 Volume $5,000 - $10,000 Volume $10,000 - $25,000 Volume $25,000 - $50,000 Volume $50,000 - $100,000 Volume $100,000 & More Volume

Equipment / Service Needs - skip if you have no equipment needs

---------------------------Select---------------------------- Nurit 2085 Nurit 2085 Plus - Internal Pin-Pad Nurit 2085U - Internal Battery Nurit 2090 Nurit 3010 - Wireless / Mobile Nurit 3020 Verifone Omni 3200 Verifone Omni 3210 Hypercom T7P Hypercom T77 Hypercom T7Plus Hypercom ICE 5500+ Talento Talento with Pin-Pad Tranz 420 Tranz 460 Omni 3750-Dial Only Omni 3750-Dial/Ethernet

---------------------------Select---------------------------- Tranz 330 - New Tranz 330 - Refurbished (Track 1) Tranz 330 - Refurbished (Track 2) Tranz 380 - New Tranz 380 - Refurbished Tranz 380x2 Zon Jr XL - Refurbished Nurit 2080 Nurit 2080 Plus Hypercom T7E - New Hypercom T7E - Refurbished Hypercom T7Plus Hypercom T8

---------------------------Select---------------------------- Verifone 1000 Nurit 252 Nurit 202 Hypercom S8 Mag-Tek MICR Mini - Check Reader

---------------------------Select---------------------------- Phone Service SmartPhone - Wireless/Mobile Nurit 3010 - Wireless/Mobile ComStar Wireless Pager Nurit 8000

---------------------------Select---------------------------- PCCharge Pro PCCharge Express Internet Payment Gateway

---------------------------Select---------------------------- Cart Manager Internet Payment Gateway e-Commerce Enabled Web Site & Acceptance Virtual Terminal

 Ownership Information

---------------------------Select---------------------------- Sole Proprietor Partnership Corporation Limited Liability Corporation

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Other

---------------------------Select---------------------------- Purchase with credit card Purchase by company/personal check Purchase by ACH checking withdrawal I want to lease my equipment

---------------------------Select---------------------------- Internet Postcard Mailing Yellow Page Ad Referred by An Existing Merchant Other Search Engine Directory

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---------------------------Select---------------------------- Have not spoken with a Sales Rep Bill Johansen Dick Chandler Paul Bogdan Tom Nelson Daniel Gargulio Jack Chevalier Jana Motyka Natalie Bryn Paige Labozzo Regina Lannomico Sharon Kratz