Step One - Merchant Information     Required form fields are marked with ( * ) * DBA (Doing Business As) Name * Best Contact Phone Number * Legal Name of Business * Company Contact First Name * Company Contact Last Name * Title or Relationship * E-mail Address * Merchant Website URL * Business Phone (e.g., 1112223333) * Business Fax * Business Address * Business City * Business State Please Select Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Business ZIP/Postal Code * Do you wish to process: Visa®/MasterCard®/Discover® American Express® Step Two - Owner Information * Principal's First Name * Principal's Last Name * Home Phone  (e.g., 1112223333) * Ownership % * Home Address Click if same as business address * Home City * Home State/Country Please Select Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Home Zip Code Step Three - Business Information * Describe Products Sold (e.g., I sell toys) * Business Ownership Type Sole Proprietorship Partnership Public Corporation Private Corporation Non-Profit Corporation Limited-Liability Company Medical or Legal Corporation Associations/Estates and Trusts Tax Exempt Organizations (501C) Government (Federal/State/Local) International Organizations * Home Business? Yes No * Average Monthly Volume $ * Average Sale/Ticket Amount $ * Business Type Retail Storefront Restaurant Office Outside Sales Outside Service Tradeshow Telephone Sales Mail Order Sales Homebased Internet Other * Years or Months in Business * Please, If You Remember, Where Did You Hear About Us? * Please Feel Free to Send Us Any Comments You May Have.