Competetive Rates * Full Service Payment Processing
www.AdultWebsitePayments.com
1-800-974-1557
NO UP FRONT FEES!
Available Payment Options
Membership Payments
Recurring Billing
900 Phone Billing
Website Integration / Cart
Multiple Sites 1- Account
Full Access Gateway
Custom Payment Pages
ACH & E-Checks Online
Fraud Scrubbing / Security
Virtual Terminal
24 Hour Support Center
Custom Reports
Multi Lingual
Multi Currency
99% Approval Rates
Fast Setup
Multiple Payment Solutions to choose from
** Call toll free 1-800-974-1556
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Merchant Application
Your Contact Information
Business Legal Name:
Trading as / DBA:
Your Name:
Your Website:
Email Address:
Alternate Email Address:
Phone Number:
Fax Number:
Cell
Number:
Address 1
:
Address 2
:
City
:
State
:
Zip / Postal Code
:
Country
:
Incorporated Country/State
:
Are you Currently Processing?
Ownership Type
Sole Proprietor
Partnership
Private Corp
Public Corp
LLC
Nonprofit
Educational
Government
Specific Business Information
Total cash, check and credit card sales per year:
Expected monthly credit card sales:
Average ticket:
Minimum ticket:
Maximum ticket:
Monthly chargebacks:
Monthly returns:
Business Type
Retail Card Swipe
Mail / Telephone Order
Signature on File
Internet / eCommerce
Other - please specify:
How You Found Us
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Marketing Flyer
Mailed Postcard
Business Card
Other Publication
Google
Yahoo
MSN
Other Search Engine
Link from Website
Word of Mouth
Referral
Other
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