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Company Name
Contact
Phone Number
Email Address
How much do you currently accept in monthly charges?
Choose one
Under $5,000/month
$5,001 - $10,000/month
$10,001 - $20,000/month
$20,001 - $40,000/month
$40,001 - $100,000/month
Over $100,000/month
What is the average ticket amount?
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$1 - $50/transaction
$51 - $100/transaction
$101 - $1000/transaction
$1001+/transaction
How do you accept credit cards and/ or ACH today?
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Face-To-Face
Phone
Internet
All of the above
Notes
