MERCHANT ACCOUNT APPLICATION & FREE RATE QUOTE FORM STEP ONE - Please complete this form if you would like to begin accepting credit cards. After providing us with basic information about your business you will receive a FREE Rate Quote and the opportunity to review and print our service agreement before submitting it to our automated approval system "in the last step of the approval process." Limited Time Offer... FREE* American Express® Setup ($100 Value FREE!) FREE* Discover® Setup ($100 Value FREE! - Plus... annual FEE waived!) Name of Business: This is the "Legal Business Name" DBA (Doing Business As, if different then "Name of Business") Street Address: (no P.O. Boxes) City:        State: Zip: Business Telephone: Business Fax: Merchant Web site Address: (If applicable)   Age of Business (Yrs.)   (Months)   List Type of Business/Products/Services Sold and How (Please be specific)     OWNERSHIP INFORMATION Business Ownership Classification: Example: Sole Proprietorship/Partnership/Limited Liability Company, etc... Select from the list Sole Proprietorship Limited Liability Company Partnership Private Corporation Corporation Public Corporation Medical or Legal Corporation Nonprofit Corporation Associations / Estates and Trusts Government (Federal/State/Local) Tax-Exempt Organization (501C) International Organization Principal's Name: Title: Ownership %: Home Telephone: Street Address (Physical address-no P.O. boxes:   City:   State:   Zip:     MONTHLY SALES VOLUME   Anticipated Average Visa/MasterCard Sale (in dollars): Estimated Highest VISA/MasterCard Sale (in dollars): Anticipated Monthly VISA/MasterCard Volume (in dollars) How will your credit card transactions take place? Enter all that apply, must equal 100% % Face to Face (Card Swiped) % Internet % Mail Order % Telephone Order % Total   OTHER ENTITLEMENTS Once you are approved you will be able to accept Visa and Mastercard credit cards. Please indicate below if you would also like to accept American Express and/or Discover credit cards.   Would you like to accept American Express? Yes No Would you like to accept Discover Cards? Yes No   Will you require a credit card processing machine? (If your sales are made via the internet you can authorize cards through our web interface:   Yes No Type of Account (Select from the list) Select from the list Retail/Wholesale Restaurant Mail Order/Phone Order Internet Mobile Business   APPLICATION STATUS E-MAIL: ISP/CSP E-mail (What E-Mail address would you like the merchant application status sent to? This should be your own personal email address:) Your Questions or Comments

Completing this form is the fastest way to get started accepting credit cards. An agent may also contact you to complete the approval process. "You are under no obligation by completing the form"

© 2006 CREDIT CARD MARKETING CENTER LLC. All rights reserved.
All trademarks, service marks and trade names referenced in this material are the property of their respective owners. FDIS #20264 is an Independent Agent Office of Cardservice International.

The First Data Independent Services Sales agent program is operated by
Cardservice International, Inc. Cardservice International is a registered ISO/MSP for the following FDIC-insured banks:
First Financial Bank, Englewood, CO; Wells Fargo Bank, N.A., Walnut Creek, CA. American Express and Discover require separate approval.

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Credit Card Marketing Center L.L.C. Restrictions apply, please call for more details