Request
for Gateway and Merchant Account Quotes
From TrustCommerce
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ORGANIZATION
INFORMATION
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NAME
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DBA NAME
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ADDRESS
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CITY / STATE
/ ZIP
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PHONE NUMBER
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FAX NUMBER
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Tax Exempt?
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Yes
No
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Fed Tax ID:
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PRIMARY
CONTACT (Billing)
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NAME
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TITLE
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PHONE NUMBER
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FAX NUMBER
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CELL NUMBER
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EMAIL
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BILLING
ADDRESS (If different than above)
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ADDRESS
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CITY / STATE
/ ZIP
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PHONE NUMBER
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FAX NUMBER
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TECHNICAL
CONTACT (If different than billing)
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NAME
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TITLE
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PHONE NUMBER
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FAX NUMBER
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CELL NUMBER
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EMAIL
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“BUSINESS”
SUMMARY
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Years “in
Business”?
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Describe
your services
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Who is your
commercial Bank?
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CURRENT
MERCHANT ACCOUNT
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Who is your
merchant account with?
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What cards
do you accept?
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Average
number of monthly transactions
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Average
ticket price
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(Ave $'s/Transaction)
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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.
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Click on
submit button to send confidential request for quote to
trustcommerce.
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This
form is provided by Proven Software, Inc. to clients
and potential clients as a free service.
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.
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