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Fill out our pre-qualification form

    How Did You Hear About Us?

    Other:

    First Name

    Last Name

    Your Email

    Your Phone


    Company Name

    DBA / Trading Name (optional)

    Company Street Address

    Company City, State, Postal, Country

    Country of Incorporation


    Description of products or services

    Web Site URL(s)

    Test Username

    Test Password

    Customer Support Number

    Customer Support Email

    Method of Acceptance (must equal 100%)
    % Web/online sales % MOTO/call center % Swipe/POS

    Target Markets (must equal 100%)
    % USA % Europe % Asia % Latin America % Other


    Do you need credit card processing?

    Do you currently accept credit cards?

    How long have you been accepting credit cards?

    Current Payment Service Provider(s)

    Reason for Change

    I can provide 3 months processing statements:

    Monthly Credit Card Total Sales Volume

    Average Single Transaction

    Highest Single Transaction

    (Please include currencies eg USD, EUR, GBP. If you are a startup please use projected figures.)


    Do you need eCheck (ACH) processing?

    Do you currently accept eChecks?

    How long have you been accepting eChecks?

    Current Payment Service Provider(s)

    Reason for Change

    I can provide 3 months processing statements:

    Monthly eCheck Total Sales Volume (in USD)

    Average Single Transaction

    Highest Single Transaction

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


    Do you need SEPA direct debit processing?

    Do you currently accept SEPA direct debit?

    How long have you been accepting SEPA direct debit?

    Current Payment Service Provider(s)

    Reason for Change

    I can provide 3 months processing statements:

    Monthly SEPA Direct Debit Total Sales Volume (in EUR)

    Average Single Transaction

    Highest Single Transaction

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


    Do you need UnionPay processing?

    Do you currently accept UnionPay?

    How long have you been accepting UnionPay?

    Current Payment Service Provider(s)

    Reason for Change

    I can provide 3 months processing statements:

    Monthly UnionPay Total Sales Volume

    Average Single Transaction

    Highest Single Transaction

    (Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.)


    Do you need Latin America local processing?

    Monthly Latin American Total Sales Volume (in USD)

    Average Single Transaction

    Highest Single Transaction

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


    Do you need local bank transfer processing?

    Monthly Local Bank Transfer Total Sales Volume

    Average Single Transaction

    Highest Single Transaction

    (Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.)


    Do you need cryptocurrency processing?

    Monthly Cryptocurrency Total Sales Volume

    Average Single Transaction

    Highest Single Transaction

    (Please include currencies (eg USD, EUR, GBP). If you are a startup please use projected figures.)


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