BPay 1206 MERCHANT PROCESSING APPLICATION AND AGREEMENT BPay1206(ia)Processing Application and Agreement • June 25th, 2009
Contract Type FiledJune 25th, 2009BUSINESS NAME(S) MERCHANT PROFILE Business Name/DBA Website Location Address Email City, State, Zip Location #OF Expected Card SalesMO YR Contact Name Type of Business RETAIL MOTO E-COM Type of Goods/Service Sold Phone Number Fax Number Seasonal Sales Average Ticket Max Ticket Business Legal/Mailing Name High Volume Months Reason for Leaving Current Processor Legal/Mailing Address Current Processor *If processing must include current statements with application City, State, Zip Method of Sales Store Front % Internet %MOTO %Tradeshow % TOTAL 100% Elec Data Capt % Key Ent w/Imprint % Key Entered CNP % TOTAL 100% B2C % B2B % TOTAL 100% Contact Name Phone Number Fax Number COMPANY INFORMATION Ownership TypeSole Prop. Government Corp S,C LLC International Org Partnership Medical/Legal Corp Tax Exempt State/Country Business Filed Federal Tax ID Name of Previous Business Prior Bankruptcies?Discharge Date Yes No Business Personal Business Open Date Length of Current Ownership Trade