Accept Major Credit Cards Via Internet Software!

[MAILER-DAEMON at NET.BIO.NET]

Lease to own merchant account equipment or software and shopping cart system for only $39.95 per month (includes bank account set up) 

WE CAN GUARANTEE APPROVAL no matter what your credit status may be!

The benefits include:

* 2% Discount Rate

* No Monthly Minimum Billing Fee

* No Statement Fee if No Sales Made for the Month

* Money Available in 2 Business Days

* Windows-Based or Macintosh Compatible Credit Card Processing Software (Technical Help Included)

* Shopping Cart System To Take Orders Securely Right On-Line (Technical Help Included)

* Checks By Fax/Email/Phone software. (optional)  

* We Can Guarantee Approval for any legal business!!!!!

* Purchasing of software/equipment is also available

Please feel free to call us at 912-236-6676 for more information or fill
out the form below and we'll contact you! 

========================================================

(There's Absolutely No Obligation When Filling Out This Form)

         <<<<<<<Merchant Account Application>>>>>  

Please fax this application to 912-236-6676 (Do not Email!)

Legal Business Name: ____ 
State: __________________   
DBA: ____________________              
Business Address: _______ 
Suite: __________________   
City State Zip: _________      
Describe Business: ______     
Business Hours: _________   
Percent Mail Order: _____     
Percent Phone Orders: ___    
Percent Trade Show: _____     
Locations: ______________     
Year Started: ___________     
Fed Tax ID: _____________         
State Tax ID: ___________       
Principal Contact: ______        
Title: __________________            
Phone No: _______________            
Fax No: _________________              
Est Card Sales Month: ___           
Average Ticket: _________           
Type of Business: _______    
State Incorporated: _____         
Age of Business: ________          
Date Acquired: __________         


OWNER PRINCIPAL INFORMATION: 

President Owner: ________ 
Title: __________________          
Ownership: ______________   
SS Number: ______________   
Residence Address: ______        
City State Zip: _________       
Own Rent: _______________        
Since: __________________        
Home Phone: _____________        
Previous Address: _______     
DOB: ____________________        


CO OWNER INFORMATION: 

Co-Owner: _______________ 
Title: __________________         
Percent Owned: __________   
SS Number: ______________     
Residence Address: ______     
City State Zip: _________     
Since: __________________     
Own Rent: _______________      


BUSINESS TYPE: 

Type of Building: _______ 
Found EMS By: ___________        
CREDIT INFO: 
Rank Your Credit: _______ 
Prior Bankrupt: _________         
Year: ___________________ 


TERMINAL: 

Prefer PC Software or Terminal?: ___ 
Terms/Lease or Purchase?: __________________           


REFERENCES: 

BUSINESS REFERENCES: (Please list three)


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