Merchant Processing Assessment to Accept Credit Cards

Thank you for considering Liberty Enterprises for your Internet credit card Payment Solution. This form will allow us to undertake a rapid business assessment of your company as a potential customer. All information is completely secure and will only be used for the purposes of assessing your application.

Contact Information

• Incorporation Name:

• Location of Incorporation:

• Business Type:E-commerce, Pharmaceutical, etc.)

• Main Web Address:

• Contact Person:

• Contact Telephone Number:(Please ensure you include the area code and that your number is correct)

• Hours of Contact:

• Contact Email Address:

Transaction Information

• Are you currently processing with credit cards?

  YesNo

• If so, which company have you processed with?

• (Expected) Monthly Amount Processed:

• Maximum Single Transaction:

• Current Chargeback %:

• Total Credit Card Sales Volume for the Last 12 Months:

• Expected Percentage of Credit Cards by Phone:

• Expected Percentage of Credit Cards by Internet:

Other Information

• How do you market your website?:

• Would you like to receive our newsletter?

  YesNo