CardService International
For assistance call Liana at 1-800-769-7695
 We would like to accept:
Visa/MasterCard Discover
American Express Debit Card
Direct Check Other
Legal Name of Business:
 
E-Mail:
Contact:
Type: Corporation
  Partnership
  Proprietorship
D B A: Phone: Business Fax:
Street Address: City: County: State: Zip Code:
Street Address (if different than above): City: County: State: Zip Code:
Type of Business: TAX I.D.#: Business License #: Age of Business
YRS:
MONTHS:
Marketing Method: Retail: Mail Order: Trade Shows: Service: Other:
Business Hours:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
From:
To:

Principal #1

Name: Ownership %:
Drivers License #:
State:
Expiration:
D.O.B.:
Home Phone: Social Security #:
Street Address: City: How Long
YRS:
MONTHS: 		State: Zip Code:
Previous Street Address (if less than 3 years): City: How Long
YRS:
MONTHS: 		State: Zip Code:
Name of Realtive (not living with you): Address: Phone:

Principal #2

Name: Ownership %:
Drivers License #:
State:
Expiration:
D.O.B.:
Home Phone: Social Security #:
Street Address: City: How Long
YRS:
MONTHS: 		State: Zip Code:
Previous Street Address (if less than 3 years): City: How Long
YRS:
MONTHS: 		State: Zip Code:
Name of Relative (not living with you): Address: Phone:

Bank: Account #: Phone: Contact:
Trade: Account #: Phone: Contact:
Trade: Account #: Phone: Contact:
Average Size Credit Card Sale: Visa/MasterCard monthly sales estimate:

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