AMG Merchant Accounts

Name of Business:
Contact Name:
Title:
Business Address:
City:
State:		Zip Code:
Phone number where you can best be contacted:
Best time of day to be contacted:		EST
Email Address:
Business Fax:

Have you previously spoken with a AMG sales person via e-mail, or telephone?		Yes No

If Yes, please enter the name of the person:



Type of account:

Does your business currently accept credit cards?		Yes No

If Yes, what is the name of the processor:

Anticipated monthly VISA/MasterCard volume:

Anticipated average credit card sale (in dollars):

Comments: