|
Please complete the merchant
account "Custom Quote" form below. A merchant
service specialist will contact you within 24 hours
to answer your questions and help you get started.
Or call us toll free
for immediate assistance:
1-800-974-1557
|
|
| Your
Contact Information
|
| Your Name:
|
| Company Name:
|
| Email:
|
| Address:
|
| City:
State:
Zip:
|
| Website Address:
|
| Phone Number:
|
| Fax Number:
|
| Cell Phone Number:
|
| Best time to reach you:
|
| Preferred
Contact Method: |
|
email
telephone
cell phone
fax
postal
any |
| Does
your business currently accept credit cards? |
|
Yes
No |
| If
yes, what company currently handles your processing? |
|
|
| What
type of processing methods will you employ? ** hold
down Ctrl key to make multiple selections |
|
|
| Type
of Products or Services you provide (100 words or less) |
|
|
| Anticipated
Monthly Visa/Mastercard Volume |
|
Under $5,000/month |
|
$5,000 - $10,000/month |
|
$10,000 - 25,000/month |
|
$25,000 - 50,000/month |
|
$50,000 - $100,000/month |
|
$100,000 - $200,000/month |
|
$200,000 - $300,000/month |
|
$300,000 - $500,000/month |
|
$500,000 - $600,000/month |
|
$600,000 - $750,000/month |
|
$750,000 - $1,000,000/month |
|
$1,000,000 + per month |
| Anticipated
Average Individual Sale - example: 45.00 (fourty
five dollars) |
|
|
| What
types of services do you currently use? **
hold down Ctrl key to make multiple selections |
|
|
| When
do you anticipate needing your merchant account? |
|
| Additional
Comments or Questions |
|
|
| If
you have a Promo Code, please enter it below |
|
|
| Please
make sure you have filled out all fields before clicking
submit |
Advanced
Merchant Group is a registered ISO / MSP of BancorpSouth
Bank, Tupelo, MS. American
Express and Discover require separate approval.
|
