1st Federal Financial Inc. - Merchant Solutions

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Please fill out this form as completely as possible. However, if there is any information that you do not have available or any question you do not understand, simply leave that section blank, and our qualified staff will help you to obtain the missing information when we process your application. We are here to make sure that your merchant account application process is prompt and pleasant.

Your information will be kept completely confidential and will not be shared with anyone under any circumstances.

Company Information
Owner's Name:	Mr.Mrs.Other
First:
Middle Initial:
Last:
Type of Ownership:
Ownership Percentage:	%
Is This a Home-Based Business?:	YesNo
Date of Birth: (MM/DD/YYYY)	/ /
Contact Name, If Different:
Legal Name of Business:
Doing Business as (DBA): (if applicable)
Company Address
Location of Business: (No P.O. Boxes. If Home-Based, Enter Home Address)
Suite or Apartment #: (if applicable)
City:
State:
ZIP:
Country:	United StatesOther
If home address is the same as business address, click this box:
Home Address:
Suite or Apartment #: (if applicable)
City:
State:
ZIP:
Country:	United StatesOther
Home Phone Number:
Business Phone Number:
Best Number To Contact:
Fax Number:
Your Email Address:
Your Website Address: (if applicable)
Credt Card Sales Information
What Product or Service are you Selling?: (i.e. I sell flowers)
Estimated Average Individual Credit Card Sale Amount: $
Estimated Total Monthly Credit Card Sales: $
Please Feel Free to Send Us Any Comments You May Have:

You will also be required to submit a signed hard copy of your application

** All Information Provided Will Remain Confidential **

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1st Federal Financial Inc is a registered ISO/MSP of Wells Fargo Bank, N. A., Walnut Creek, CA
© 2008 1st Federal Financial Inc.