Request for Gateway and Merchant Account Quotes
From TrustCommerce

ORGANIZATION INFORMATION

NAME

DBA NAME

ADDRESS

CITY / STATE / ZIP

PHONE NUMBER

FAX NUMBER

Tax Exempt?

Yes No

Fed Tax ID:

PRIMARY CONTACT (Billing)

NAME

TITLE

PHONE NUMBER

FAX NUMBER

CELL NUMBER

EMAIL

BILLING ADDRESS (If different than above)

ADDRESS

CITY / STATE / ZIP

PHONE NUMBER

FAX NUMBER

TECHNICAL CONTACT (If different than billing)

NAME

TITLE

PHONE NUMBER

FAX NUMBER

CELL NUMBER

EMAIL

BUSINESS” SUMMARY

Years “in Business”?

Describe your services

Who is your commercial Bank?

CURRENT MERCHANT ACCOUNT

Who is your merchant account with?

What cards do you accept?

Average number of monthly transactions

Average ticket price

(Ave $'s/Transaction)

This information, as with all information provided to TrustCommerce, is strictly confidential. TrustCommerce does not sell, distribute, or provide this information to any other organization.

Click on submit button to send confidential request for quote to trustcommerce.

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Proven Software does not participate in any way in the credit decisions of TrustCommerce,
nor does Proven Software receive direct or indirect compensation from TrustCommerce for account referrals.

Your submission will be sent to Proven Software. This information, as with all information provided to Proven Software, is strictly confidential.
Proven Software does not sell, distribute, or provide this information to any other organization.