| NPS sales agent name (if any) |
|
| Your Business Name |
|
| Contact Name |
|
| Address |
|
| City |
|
| State |
|
| Zip code |
|
| Contact telephone number |
|
| Fax number |
|
| Email address |
|
| Web site address |
|
| Type of business and/or products sold: |
|
| Do you already accept credit cards? |
|
| If you answered "yes" to the previous question, for how long have you accepted cards... |
|
| ...and what is your estimated amount processed annually? |
|
| In which NPS services are you interested? (select as many as you wish) |
Credit Card Processing
PIN-Based Debit
Electronic Check Processing |
Gift Loyalty Programs
Short-term Capital Financing
All of the services |
| |
|
| How did you
hear about us? |
|
| If you were referred, by whom? |
|
| Questions/Comments |
|
| Preferred method
of contact |
|
| Best Time of
Day to Call |
|
Enter Security Code From Above:
|
| |
