FILL OUT THIS FAX-EMS.TXT FORM AND UPLOAD or FAX TO US!

    Get you're business set up with VISA\MC - 95% Success rate!
    Consultants, Home Business, BBS's, Reseller's, Phone Orders.
   
  ** FAX-EMS.TXT is the file name if you have a modem\fax board.
     Or press "P" NOW! to print this form out to FAX on your machine
     or to E-Mail it on CompuServe or regular snail mail it to us.
 
   Business Information Questionnaire: Please FAX to: 916-381-8746
   or E-Mail Application on CompuServe: Kevin King ID 75024,2222
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     ** PLEASE ANSWER QUESTIONS WITH UPPER CASE LETTERS, THEN FAX! **

    1) Business Name:
   
    2) Name of Owner/Guarantor
   
    3) Phone 1:
  
    4) Phone 2:

    5) FAX:

    6) Address

    7) City\State\Zip

    8) Product or Service Sold


    9) Advertising Method


   10) %Phone\Mail\Fax\Email Order

   11) %Home: ______ %StoreFront:_______

   12) Type Ownership: ( ) Corporation  ( ) Partnership ( ) Sole Owner

   13) Date Business Started: __/__/19__

   14) Credit: ( ) Excellent ( ) Fair  ( ) Poor  ( ) Past Bankruptcy

   15) Are you interested in the lease or cash purchase of the terminal?

   16) When might you wish to proceed with opening your account?


   17) Notes/Comments: