Nextdayfunding.com Secure Merchant Account Application

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Merchant Account Application

* denotes a required field

Company Information
Business Name*
Contact Name*
Contact Title*
Street Address*
Street Address cont.
City*
State*
Zip*
Phone Number*
Fax Number
Email Address*
Do you already have a merchant account?	yes no
Would you like to be contacted in the future regarding special offers or announcements?	yes no
Comments
Business Profile
Type of Ownership*	Sole Proprietor Partnership PA or PC Corporation Limited Liability Company Not for Profit
Type of Goods Or Services Sold*
Merchant Type*	Retail Restaurant Lodging Service Other
Visa/MasterCard Sales Profile*	Card Swipe	%
	Manual Key Entry with Imprint, Card Present	%
	Mail Order/Telephone Order	%