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Personal Information

Full Name *

Email *

Phone *

Date of birth *

Social Security Number *

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Home Address *

Home Address 2

Home Zip Code *

Home City *

Home State *

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Business Information

Address *

Address 2

Business zip code *

City *

Business State *

AK
AL
AR
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DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
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MO
MP
MS
MT
NC
ND
NE
NH
NJ
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NV
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Business Name *

Max Length: 30 characters

Business Incorporation Type *

Business Incorporation Type

Association/Estate/Trust
Corporation
Government
International
LLC
medical/Legal
Non-Profit
Partnership
Sole Proprietor
Tax Exempt
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Business Industry *

Business Industry

0742 - Veterinary Services
0780 - Horticultural and Lanscaping Services
1520 - General Contractors
1799 - Contractors, Special Trade Contractors
4119 - Ambulance Svcs
4121 - Taxi and Limo
4215 - Courier Svcs
4468 - Marinas, Marine Svc/Supplies
4722 - Travel Agencies
5013 - Motor Vehicle Supplies
5021 - Office and Commercial Furniture
5045 - Computers, Peripheal Equipment, Software
5047 - Dental/Lab/Medical/Hospital Equipment and Supplies
5111 - Stationary and Office Supplies
5251 - Hardware Stores
5261 - Lawn and Garden Supply Stores
5331 - Variety Stores
5411 - Grocery Stores
5462 - Bakeries
5499 - Misc Food Stores
5511 - Auto and Truck Dealers-Sales, Service, Repairs
5533 - Auto Parts and Accessories Stores
5691 - Men's and Women's Clothing Stores
5712 - Home Furnishing Stores
5811 - Caterers
5812 - Eating Places and Restaurants
5813 - Bars, Nightclubs and Taverns-drinking places
5814 - Fast Food Restaurants
5912 - Drug Stores and Pharmacies
5921 - Package Stores-Beer, Wine and Liquor
5942 - Book Stores
5944 - Jewelry Stores
5945 - Toy Stores
5947 - Card,Gift and Novelty Stores
5977 - Cosmetic Stores
5992 - Florists
5995 - Pet Shops, Pet Food and Supplies
7011 - Lodging-hotels, Motels,Resorts
7230 - Barber & Beauty Shops
7261 - Funeral Services
7298 - Health & Beauty Spas
7299 - Other Services-not Elswhere Classified
7349 - Janitorial & Cleaning Services
7372 - Computer Programming and Design Services
7393 - Security & Protective Services
7394 - Equipment Rental
7512 - Automobile Rental Agencies
7531 - Auto Repair Shops
7542 - Car Wash
7549 - Towing Services
7932 - Pool & Billiard Halls
7933 - Bowling Alleys
7996 - Amusement Parks and Carnivals
8021 - Dentists & Orthodontists
8043 - Opticians,Optical goods, Eyeglasses
8050 - Nursing and Personal Care Facilities
8071 - Dental and Medical Labs
8099 - Health Practioners, Medical Services
8111 - Attorneys & Legal Services
8351 - Childcare Services
8999 - Professional Services
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Merchandise/Services Sold *

Business Job Title *

Ownership Percent *

Business Start Date *

Business Tax ID Type *

SSN

EIN

Business Tax ID *

Please enter a 9 digit number

Monthly Average Processing Volume *

Average Ticket price *

High Ticket price *

Choose the Hardware best suited to your business:

3-in-1 Reader

Pax A80

A920Pro Wireless

Smartflex

Smart pos+

Smart Mini (PAX A77)

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