Electronic Transfer,inc

Contact Name:

Business Phone:

Best Time to call:

EMail:

Business Address:

City, State, Zip:

Product / Service Sold:

Average Sale Amount:

Do you Currently Accept Credit Cards:

How are Sales Conducted ?

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Features Of the Fast Charge Payment GatewayTM

Free Online Virtual Credit Card Processing Terminal
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Free Recurring Billing - Monthly, Quarterly or Annually etc..
Free Basic Shopping Cart
Free Fraud Scrubbing
Free 24 X 7 Toll Free Telephone Support
Free Sub ID's and Unlimited Users
Free Address Verification Service (AVS)
Free Order Email Receipt to Customer and Merchant
Free SSL Secured Order Pages
Free No Equipment or Software Needed
Free Instant Credit Card Verification
Free Real-Time Online Reporting
Free Email Domain Validation
Free Large Transaction Notification
Free Negative Credit Card Database for Fraud Detection
Free High Risk Country and IP Address Blocking
Free Daily Batching
Free Batch Processing
Free Duplicate Transaction Prevention
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* This form is for US based businesses only. If you have a Non-U.S. based business please check out our international program here: Non US Merchants

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Owner 1 Name:

Percent Owned:

Owner2 Name
(Leave Blank If Sole Owner):

Percent Owned:

Contact Name:

Email Address:

Best Phone Number To Reach:

Legal Business Name:

Doing Business As (DBA):

Business Street Address:

City:

State:

Not a US based business?

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Business Zip Code:

Business Country:

Business Phone Number:

FAX Number:

Date The Business Opened
(Month/Day/Year):

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Product, Service or Merchandise Sold:
Type of Business? (Corporation, Partnership, Sole Ownership, etc.):
% Internet Orders:
% Mail/Phone Order:
% Face To Face (Swiped):
Estimated Average Credit Card Sale:
Estimated Credit Card Monthly Volume:
WWW Site Address:
Have You Ever Accepted Credit Cards?:
If Yes, Do You Currently Accept Credit Cards?

Which particular search engine brought you here and what search term did you use to find us? Example: Google.com - searching for merchant accounts. Or Which Magazine, Post Card, Friend or Other Advertisement Etc.

How Did You Hear About Us? (* Note: This has to be filled in for the form to work.):

What Kind Of Equipment Or Online System Do You Want To Process Your Credit Card Orders (Note: Banks Now Require Transactions To Be Conducted Electronically-Paper processing Is No Longer Available)

Equipment Needs:

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Home Address:

City:

State:

Not a US based business?

Click Here for our Premier International Payment Program

Zip Code:

Home Phone Number:

Rent or Own?

What is your credit rating?:

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