Pre-Application Form

Check all that apply
Credit Card Processing Check Processing
Have IMS contact you directly to expedite approval
Agent Information
Agent Code
Agent Name
Agent Phone Number - ### - ### ####
Agent Fax Number - ### - ### ####
Merchant Information
Company Name
Doing Business As
Name First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Work Phone - ### - ### ####
Cell Phone - ### - ### ####
Home Phone - ### - ### ####
Fax Number - ### - ### ####
Email
Web Site
Business Profile
Describe your business
Years In Business
Estimated Monthly VISA/MC Volume
Average Ticket
Highest Ticket
Have you ever processed credit cards before
Yes No
Sales Profile
Reason for requesting account
TMF Poor Credit Score Capped Volume New Business High Chargebacks Unknown (explain)
Please specify if Unknown
How do you plan to process credit cards
Retail Moto Internet Manual Swipe Wireless Other (explain)
Please specifiy if other