Prospect Pre-approval Form Page

Please complete the following information:

 
Where are you located?
Establishment Name*
Street    
(No PO Box)
City State Zip Code
Telephone Fax  
 
Best Time to Call    
 
Website    
 
Name of Parent Corporation (if applicable)  
 
First Name of Owner Last Name of Owner*  
 
E-mail Address*    
 
   
Tell us about your restaurant.
What year did the establishment open?*		  
 
How long have you owned the establishment?*  
 
What cuisine does your restaurant serve?  
 
What is the average price of your products or services?  
 
   
Tell us about your success.
What percentage of your business is paid by credit card?* 		 
%  

Based on your most recent statements, what were your total monthly sales volumes on:*
$ MasterCard®
$ Visa®
$ Discover® Card
$ Diners Club®
$ American Express®

What POS system do you use?
Who is your credit card processor?
What is your merchant number?
What is the purpose of the funds you seek?
Other
How did you hear about us?*

If other, please specify



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