How were you referred to AMS:

Products/Services you are seeking:

Business Name:

Business Address:

City:

Country:

Phone:^*

Fax:

Website:

Contact Name:^*

Email Address:^*

Are you a startup:

Age of business:

Products/Services Sold:

Retail Storefront:

Mail Order:

Inbound Phone Sales:

Outbound Telemarketing:

Internet:

Current Monthly Volume: $

Projected Monthly Volume: $

Average Credit Card Transaction: $

Highest Credit Card Transaction: $

If so, by what banks/processors?

Who do you currently process with?

What banks/processors have you processed with in the past?

Why are you not with them anymore?

Who have you applied with so far?

How is the signers personal credit?

Credit Score:

Comments: