Please leave this field empty.

1. Business History?

New business?Existing business?

3. Industry?

RetailRestaurantOffice (dental, doctor, etc.)WholesaleOnlineNon-profitOther

5. Expected or current total monthly gross sales?

$2,500 and below$2,501 - 5,000$5,001 - 10,000$10,001 - 20,000$20,001 - 50,000$50,001 - 99,000$100,000+

7. Expected or current monthly credit card sales?

$2,500 and below$2,501 - 5,000$5,001 - 10,000$10,001 - 20,000$20,001 - 50,000$50,001 - 99,000$100,000+

9. How soon would you like to begin processing with BPS?

Within 48 hours.Within the next week.Within the next month.Not sure.

2. Ownership Type?

Corporation - C or S CorpSole ProprietorshipPartnershipLLC - Limited Liability CorporationOther

4. How will / do you accept credit cards?

RetailMobile DeviceOnlineWebstoreNot Sure

6.Anticipated average charge?

$5 - 10$11 - 20$21 - 50$51 - 100$101 - 250$251 - 500$501+

8. What equipment do you need?

Landline / IP Credit Card TerminalWireless Credit Card ReaderWebsite Shopping CartAuthorize.net Virtual TerminalReprogram existing equipmentNot sure

10. Would you be interested in working capital up to $25,000?

YesNo

Legal Business Name

Contact Name

Phone

Website

Email

Street Address

Back To Top