ABP

Alliance BankCard Processing, LLP

1837 W. Gump Road

Huntertown, IN 46748

Phone 888-783-4690  or  260-338-0993    Fax 260-338-0995
Email: rick@abpvisa.com

A Member Service Provider Nova/US BankCorp, St. Louis, MO

Please provide the following contact information:

Legal Name of your Business, Corp, LLC     (Not your DBA)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Business Phone
Business Phone #2
Business Fax
Company Website URL/Address
Company email address
Fed Tax ID# or SS#
Type of business	Choice Corporation Sub_S_Corp Partnership Sole_Proprietorship LLC
How long  in business?	Choice Yes No	Years
Do you have Prior Experience in this Business?	Choice Yes No		Years	Choice 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 More_then_16
How long at the above address?	Choice 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 More_then_16
DBA Name
Is the address of your DBA the same as above	Yes No
Enter your DBA address if NOT the same as above
DBA Street Address
DBA Address (cont.)
DBA City
DBA State/Province
DBA Zip/Postal Code
DBA Country
How long at the DBA address?	Choice N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 More_then_16 Years
Own or Rent?	Choice Own Rent
Owner #1
First Name
Last Name
Middle Initial
SS#
Birth date
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Owner #1 email address
Home Phone
Driver's License Number			State
Percent of Ownership
Owner #2
First Name
Last Name
Middle Initial
SS#
Birth date
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Owner #2 email address
Home Phone
Driver's License Number			State
Percent of Ownership
Rate your Credit Bureau Score 1 to 10	(1=Poor, 10=Great)		Choice 1 2 3 4 5 6 7 8 9 10
Bankruptcy?	Choice Yes No If yes, Discharged When?
Your Bank Name
Bank Phone Number
Bank Contact Person
Bank routing Number
Bank Account Number
Business Reference
Phone Number
Contact Person
Account Number/Name
Do you currently Except Credit Cards?	Choice Yes No
If yes, what is the name of your current processor?
Do you currently Except AMEX and/or Discover Credit Cards?	Choice Yes No
If you answered yes please input current AMEX and/or Discover ID's below
AMEX ID
Discover ID
How do you sell your products?	Percentage
Imprint Card & Hand Key Sale	%
Swipe Card Sale	%
Mail/Phone Sales	%
Internet Sales	%
Do you wish to accept:
AMEX  at %.00 per month and 0.00%:	Choice Yes No
Discover at 2.44% plus ten cents	Choice Yes No
Describe products & services sold
How long until customer receives your product?
Do you charge customer's Card before Customer Receives Product?	Choice Yes No
How long before Customer Receives Product?
Do you offer warranties or Guarantees?	Choice Yes No
Are you a seasonal Business?	Choice Yes No
Average credit card sale	$
Monthly credit card volume	$
Which merchant program are you applying for?	Choice Touch-tone Telephone AuthorizeNet PC Software
Do you need to Purchase Equipment?	Choice Yes Not Sure No
Do you have Existing Equipment or Software to reprogram?	Choice Yes Not Sure No

 

End of Form
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