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YOUR LOCAL U.S.A MERCHANT SERVICE PROVIDER FOR 20+ YEARS

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Thank you for letting us be your merchant service provider for your business

Business Tax ID EIN or TIN #

Legal Business Name

Legal Business Address

Business Phone #

DBA

DBA Address

Date Business Started

Average Ticket

Monthly Volume

Typical High Ticket

Type of Ownership:

Sole Proprietor

Corporation

LLC / LLP

Which Solution will you be using?

Mobile Solution

Cash Discount Program

Retail Terminal

Smart Terminal

Text to Pay

E-commerce

Do you currently Accept Payments?

Yes

No

Product / Service Sold

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www.cardsmartchoice.com

1-866-767-2273

The Clover trademark and logo are owned by Clover Network, Inc., a FiServ Company. All other trademarks, service marks and trade names referenced in this material are the property of their respective owners.

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