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COMPANY INFORMATION
Company Name:
Type of Business / Industry:
E-Mail Address: *
Does Your Business Currently Accept Credit and/or Debit Cards?
Who is Your Current Provider?
How Will You Process the Majority of Your Transactions?

Which Type of Cards Do / Would You Like To Accept?

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TRANSACTION PROCCESSING INFORMATION
Average MONTHLY Credit Card Dollar Volume:
Average Credit Card Transaction Size:
Average MONTHLY Number of Debit / Interac Transactions:
   

CONTACT INFORMATION
First Name: *
Last Name: *
Address: *
City: *
Province: *
Postal Code: *
Telephone: *
Fax:
How Did You Hear About Us?
 

OTHER INFORMATION
When Would You Be Willing to Make a Change / Start Processing?
Please Describe Any Additional Transaction Processing Requirements That You May Have: