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PRE-APPROVAL FORM AND MERCHANT RATE COMPARISON REQUEST

24 Hour Online Account Review

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Business Name : *
Percent of Ownership :
DBA :
Business Classification : *  
Business Phone : *
Business Contact : *
Fax # :
Type of Business :
Business Address: State : Zip : *
Billing Address (if different) : State : Zip :
Years in Business :
Email Address : *
WebSite :
Estimated Card Volume per Month :
Owner :
Home Address : State : Zip :
Home Phone :
Cell Phone :
Current Terminal Make & Model :
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