Retail rates as low as 1.55%; Mail Order/Telephone or Internet rates as low as 2.25%; Monthly fees start at 19.95! No long term commitment options. Complete this worksheet for your own special quotes. Please be truthful. We offer the best service in the industry at the best possible pricing. Don't settle for anything less. Don't get caught setting up a merchant account with a non financial institution. With USB, your account is handled directly by a federally charted savings bank. We offer 24 hours, 7 day a week customer support through a dedicated toll free number; plus your calls are answered by a live trained representative usually in under one minute! By far the best merchant bank card service in the industry.

This application is for: New Merchant - not taking credit cards Existing Merchant - Better/ More Svcs.

Business Name

E-MAIL Address (Required!)

Your home page web address, if any

Date EstablishedBusiness Telephone

Fax Number Method of Selling StoreFront MailOrder Trade Shows Door to Door Internet Other

Will you physically obtain the credit card from your customer for you to "swipe" the card? Yes, I'll usually swipe the card! No, card won't be present

Your business is located in In the U.S. Outside the U.S. - foreign country

Business Address CityState Zip

Product or Service Sold

Estimated Monthly bankcard volume: under $1000 $1K - 5K $5K - 10K 10K- 20K 20K - 30K 30K - 50K 50K - 100K over 100K

Average Ticket amount: under $50 $50 - $100 $100 - $200 $200 - $300 $300 - $500 $500 - $750 $750 - $1,000 $1,000 - $2,000 $2,000 - $3,000 over $3,000

Type of Ownership Sole Proprietorship Corporation Partnership LLC Non Profit Organization Other

Merchant Location Shopping Center Home Based Office Separate building Other Do you Own Lease Mo. to Mo. Rent

Owners of Officers Information

Principals NameTitle

Home Address CityState Zip

  Do you own or rent? Own Home Rent Home How long at current address? less than 1 yr 1 - 2 yrs. 2 - 3 yrs. 3 - 4 yrs. over 4 yrs.

Home Telephone

Personal Credit History Excellent Good Fair Poor Collections Past Bankruptcy

If past Bankruptcy, how long ago No bankruptcy - N/A less than 2 yrs. 2 - 3 yrs. 4 - 7 yrs. over 7 yrs.

How did you find our web page?

What search keywords did you use, if any?

Services Requested:

MC/Visa Acceptance American ExpressDebit/ATM

Check Service:

Check GuaranteeUniversal Total Check Check Authorization (SCAN)

Web Hosting Web Design Services

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