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PERSONAL INFORMATION
Contact Name:
Email Address:
Phone:
Address:
City:
State:
Zip:
BUSINESS INFORMATION
URL:
Business Type:
----(Select One)----
Select One
Advertising
Art
Automotive
Banking Services
Chat Room
Childrens Resources
Consulting Services
Database Access
Education
Electronic Publishing
Entertainment
Entertainment/Adult
Financial Services
Health Care
Health Services
High Tech
Horoscopes
ISP
Legal Services
Medical
Music
Networking
Organization/For Profit
Organization/Non-Profit
Personals
Political
Portal
Products/Adult
Products/General
Professional Service
Publishing
Religious
Science
Software/Downloadable
Software/Shipped
Sports Related
Virtual World
Web Design/Host
Web Designer
Web Host
Site Type:
----(Select One)----
Content based
Product based
Site is both content & product based
Other
Account Type:
----(Select One)----
I have an internet merchant account
I need an internet merchant account
I don't need a merchant account
Site Status:
----(Select One)----
Complete, not taking orders yet
Complete, already taking orders
The site is not ready to accept orders
Volume:
----(Select One)----
Currently over $100 per month
Currently over $1,000 per month
Currently over $5,000 per month
Currently over $10,000 per month
Currently over $50,000 per month
Currently over $100,000 per month
Currently over $1,000,000 per month
Processor:
----(Select One)----
Yes I am using another processor.
No, I am not using another processor.
I handle my own processing.
Comments: