How long has your business been open? Please Select Less than 1 yr 1 yr or greater

* How many years have you been in business?

Do you accept credit cards from your customers? Yes No

* How much do you process in credit cards from your customers each month? Please Select Less than $2,500 $2,501 - $5,001 $5,001 - $10,000 $10,001 - $20,000 $20,001 - $30,000 $30,001 - $40,000 $40,001 - $50,000 $50,001 - $60,000 $60,001 - $70,000 $70,001 - $80,000 $80,001 - $90,000 $90,001 - $100,000 $100,001 - $110,000 $110,001 - $120,000 $120,001 - $125,000 $125,000+

Have you ever taken money against your merchant account? If yes, what was the name of the Company?

* Marketing pieces desired:

	Jumbo Postcards
	Menus
	Letters
	Other

* What are your estimated monthly gross sales?

Products/Services Sold:

What is the main form of payment from your customers?

Total annual gross sales?

Amount of working capital you are looking for?

Typical Markup (eg., If you buy something for $1, how much do you sell it for)?

Please check the box if you are interested in any of the following offers: