Complete the following information and submit it for fast, free Merchant Account approval. We will notify you of your approval within 24 hours and confirm any remaining details.
Merchant Information
Name:
Product/service of interest:
Title:
Company:
Address:
City, State, Zip:
Telephone:
FAX:
E-Mail:
Business Start Date:
Product or Service Sold:
Type of Adult Business:
Clothing & Access
Phone
Photo/Video
Video Conferencing
Other
Marketing Method:
Internet
Mail order
Phone
Retail
Trade Shows
Processing Method:
Internet
Mail order
Phone
Retail
Business Location:
Office
Home
Retail Store
Business Type:
Sole Proprietor
Corporation
Partnership
Avg. Ccard Sale Price:
Monthly Ccard Sales:
Principal / Owner Name:
Percent Ownership:
Principal / Owner Credit:
Excellent
Good
Average
Poor
Business Credit:
Excellent
Good
Average
Poor
Fed. Tax I.D.# or S.S. #:
How to reach us:
We will respond to your Credit Card Merchant Account inquiry within 1 business day if you e-mail or fax us. If you wish to speak to a representative regarding a Credit Card Merchant Account right away, please email us at address listed below.
0-Activation
3535 East Pacific Coast Highway - Corona del Mar, CA 92625
Suite 109
E-Mail:
sales@a-quick.com
Copyright (c) 1997-1998 A-Quick Credit Card Merchant Services, All Rights Reserved. All other Trademarks or Service Names are registered trademarks or service marks of their respective owners.