REQUEST FOR
RISK FREE - NO OBLIGATION QUOTE

For a risk free no obligation quote on securing a TeleCheck Account for your business, please tell us about your business by filling out and submitting the following form. All information is strictly confidential and is used only for the purpose of requesting a quote. One of our experienced professionals will contact you by telephone within 24 hours to discuss your account options.

* Denotes Information Required for Sending Request

* Business Name
 * City, State
* Contact Name
* Email Address
* Telephone      Fax:
* Best Time to Call 
 * What is your Type of Business ?
* I am interested in getting
Credit Card Merchant Account?
  Yes        No
* I am interested in getting
Electronic Check Verification or Guarantee?
  Yes        No
* Average Monthly Check Sales  $
* Average Check Amount $
* Average monthly Returned Check Losses $
Questions/Comments

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