FREE - NO APPLICATION FEE!!
AVAILABLE TO U.S. RESIDENTS ONLY
You MUST fill out the following form as complete as possible.

Merchant Account Options
Please Choose One:
Your Home Address & General Info
First Name:
Last Name:
Email Address:
Home Address:
City, State, Zip
County: (not Country - we know you are in the U.S.)
Home Phone:
How Long Have You Lived at this Residence?:
If less than 3 years at current address list past address:
Business Address & General Info
Legal Name of Business:
DBA:
Your BUSINESS Address:
City, State & Zip of Your Business:
County: (not Country - we know you are in the U.S.)
Business Phone:
Business Fax:
Contact Name:
Best Time To Call:
# of Years in Business:
Average Ticket Price (Estimated price of an average sale):
Estimated Monthly Volume:
Tax ID Number:
Is your business product or service order based?: Product Service
If Product please specify:
Type of Ownership:
Web site (URL):
Name of Nearest Relative not living with you:
Address of Nearest Relative not living with you:
Phone # of Nearest Relative not living with you:
Banking Information
Bank Name:
Account Number:
Bank Phone Number:
Applicant Information
Self-Rate Your Credit
Applicant's SSN#
Driver's License Number
Driver's License Expiration Date:
Date of Birth: mm/dd/yy
Trade Reference #1:
Trade Reference #2:
Break your sales down in to percentage of sales venues. EX, 25% mail order, 25% telephone, 50% internet, etc.
Would you like to participate in our referral program? Yes
No
Please type any comments here
Fill out the above form and hit the submit button and it will be automatically sent to us via email. Or if you prefer you can print out this page and fax it or "snail mail" it to us.

Business Zoo
32572 Lake Tana St.
Fremont, CA 94555
Order Line: 510-487-9966
Fax: 510-487-9966

You may also call , and you can give the above information to the operator over the phone.

ACT NOW, and you too can be processing credit card orders in as little as 3 to 10 business days depending on which option you choose!

If you submit using the above form, a representative will call you back within 24 hours, unless you submit the form on a Saturday. Saturday submissions are answered on Monday.

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