New Merchant Intake Form

AGENT NAME
DATE
AGENT PHONE NUMBER

PRINCIPLE INFORMATION

FULL NAME
TITLE
EMAIL ADDRESS
PHONE
ALTERNATIVE/CELL

GENERAL BUSINESS INFORMATION

LEGAL BUSINESS
DOING BUSINESS AS
TYPE:
MerchandisingManufacturingFood ServiceHealth
NUMBER OF LOCATIONS
Hotel/EntertainmentFinancialOther  
YEAR BUS. CREATED
BUSINESS ADDRESS
STATE
CITY
ZIP CODE
BUSINESS PHONE #
FAX#
* MONTHLY CC SALES VOLUME $
AVG TICKET $
HIGHEST TICKET AMOUNT $

APPLICABLE SERVICES   (check all that apply)

SERVICES NEEDED

Are you currently Processing Credit Cards?

Visa/Mastercard/DiscoverAMEXWeb Integration
Yes (with who?)   
No

ACTION TO TAKE:

Please submit 1 month’s statement, PER LOCATION,
to docs@cpspays.com for comparison and proposal
of savings.

HOW YOU PROCESS (%)

Swiped %Keyed%Website%

WHY WE NEED STATEMENTS:

  • Only way to accurately compare rate savings. Each
    card has a different cost or interchange rate (think
    AMEX vs Debit card). We supplement our rates on
    same CC cards used so customer can evaluate a true
    savings figure.

  • Create custom pricing model that is specific for
    business type and historical card usage categories.

  • Expedite underwriting process and preapprove credit
    limitations; especially crucial for high volume, high
    ticket, or high risk accounts.

SPECIAL REQUIREMENT/NOTES:



SALES REP. EMAIL

UPLOAD FILE  (only PDF format)