911Signup - Free EMV Credit Card Terminal - Texas Business Development Center USA

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Choose Type of Pricing Option 🛈

Choose the Type of Free EMV Terminal You Need 🛈

BUSINESS AND OWNER INFORMATION

Simply fill out the fields below and then click the submit button at bottom of page

DBA - Business Name - Doing Business As - Required Field
*

Your Full Name

Cell or Mobile Phone Number

Phone Number for Your Business

Customer Service or Alt Phone Number

LEGAL NAME - IRS Filing Name - The Name You Use When You File Your Taxes

Email for Your Business 🛈

FEDERAL TAX ID (EIN)

Web Site Address

FAX Phone Number

Type of Business Ownership 🛈

Years Biz Open

Months Biz Open

DBA Business Address or PO BOX

Business Address City

Business Address State

ZIP CODE

LEGAL ADDRESS

Legal Address City

Legal Address State

ZIP CODE

Describe Your Business Products / Services 🛈

% of Sales Made Where?
Must Total 100%

	Store Front/Swiped
	Internet Orders
	Mail + Phone Orders
	Keyed - Face to Face

0/100 points

Current Processor Name

Do You Get Statements? 🛈

Monthly (Expected) Sales 🛈

Expected Credit Card Sales 🛈

Largest Sale Amount 🛈

Average Sale Amount 🛈

Your First Name

Your Last Name

Date of Birth

Owners Home Address

Home Phone Number

Home Address City

Home Address State

Home Address Zip

Your Email

Your Business Title

% Of Biz Ownership 🛈

Social Security Number (SSN)

Drivers License Number

Drivers License State

Bank Name

Your Name on the Bank Account

Bank Account Routing Number

Your Business Bank Account Number

Upload Files | Copy of Your Voided Check to Deposit Monies

Comments or Message

Your Signature - Click and Use Your Mouse to Sign 🛈

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