Does your business currently accept credit cards	Yes No
Business Name
Type of products sold or services provided
Are you currently in need of credit card processing equipment	Yes No Maybe
How much do you currently accept	Under $5,000/month $5,000 - $10,000/month $10,000 - $20,000/month $20,000 - $40,000/month $40,000 - $100,000/month Over $100,000/month
Contact Name
Contact Phone
Contact Email
Methods of accepting payments	Card Swiped Face To Face Telephone Mail Order On the go - tradeshows etc Website All of these
Comments or questions
Best Time to Contact You	Morning Afternoon Evening