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How Did You Hear About Us?

Other:

First Name

Last Name

Your Email

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Your chat platform (OPTIONAL)

Company Name

Street Address

City, State/Province, Postal/Zip Code, Country

Description of products or services

Web Site URL(s)

Primary Method of Acceptance

Web / online sales (e-commerce)MOTO / call centerPoint of Sale (Retail)

Target Markets

USA & CanadaEurope & UKAsiaLatin AmericaOther

Do you currently accept credit cards?

How long have you been accepting credit cards?

Current Payment Service Provider(s)

Monthly Credit Card Total Sales Volume

(If you are a startup, please use projected figures)

Average Single Transaction

Highest Single Transaction

Are you looking for payment options besides credit cards?

Additional Comments (special requirements, shopping cart or CRM platform used, etc)