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Artistic!'s Merchant Sign Up Form (No Application Fee If Submitted Within The Next 30 Days!!) |
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Please NOTICE :
Agent ID: 490100 |
All fields marked with * are
mandatory. If there is no applicable data for such a field enter: " -
" Some fields marked with [*] are conditionally mandatory. You must complete these fields only if the data is necessary to describe a previous selection. The more information you provide, the easier an Evaluation can be provided to you for new services. |
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| 1. CLIENT INFORMATION | |||||||||
| Last name: | * | ||||||||
| First name: | * | ||||||||
| Company: | |||||||||
| Address: | * (Home) | ||||||||
| City: | * | ||||||||
| State: | * Sorry International Applications are NOT accepted. | ||||||||
| Zip Code: | * | ||||||||
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| Phone: | * | ||||||||
| Fax: | |||||||||
| E-mail: | * | ||||||||
| URL (WWW address): | * If you have one. | ||||||||
| 2. BANK | Fill the following fields of this section only if the payment method you have selected is: "money transfer" | ||||||||
| Account number: | [*] | ||||||||
| Bank (Name and location): | [*] Full Bank Name | ||||||||
| Location: | [*] City/State | ||||||||
| Name on Account: | [*] | ||||||||
| 3. PRODUCT INFORMATION | |||||||||
| Product name: | * | ||||||||
| How long before shipment?: | * | ||||||||
| Price of Product: | * | ||||||||
| Average Sale Amount: | * | ||||||||
| Extended description of your product, service and/or your business. | * | ||||||||
| Sales Per Month: | * | ||||||||
| 4. CLIENT FOLLOW-UP INFORMATION | |||||||||
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Please provide us with the following information so we can determine the
best route to take in contacting you.
1. You are not interested
in Software as an option and would prefer to purchase or lease your
Merchant send via E-Mail (Our email address is:) send via Fax (Our Fax number is): by postal mail (Send information to:) 2. YOU ARE INTERESTED in
Software and current operate on which Operating System? Please describe below why you feel a Merchant Account is
necessary in your business. *
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5. YOUR REFERRAL
INFORMATION
(Agent Referral) Refer a friend or business and Artistic! will pay you $25.00 Artistic! Financial Services for your referral if they setup a Merchant Account. Complete Agent ID: 490100 this section and fax to: 1-866-RTISTIC! (1-866-784-7842) (Faxline available, 24 hours per day, 7 days per week.) |
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| Referral Name | |||||||||
| Business Name | |||||||||
| Referral Address (Provide business mailing address.) |
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| City, State, Zip Code (No International Referrals please.) |
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| Referral's Email (We will contact you here the fastest.) |
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| Referral's Phone # (including area code) | |||||||||
| Referral's FAX # (including area code) | |||||||||
| YOUR NAME (person referrng application) | |||||||||
| Your Address (Provide business mailing address.) |
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| City, State, Zip Code (No International Referrals please.) |
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| Your Email (We will contact you here the fastest.) |
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| Your Phone # (including area code) | |||||||||
| Your FAX # (including area code) | |||||||||
| How did you hear about our website? (If a search engine, provide name.) | |||||||||
| Agent ID #: | 490100 | ||||||||
SUBMITTAL INSTRUCTIONS:
Cut and paste the SignUp Form into email format and return to
Brandee Cooper immediately for
processing. You may print this
page and Fax to the number below for immediate call back or
prompt attention to any concerns you might have regarding your
Merchant Application.
Email Brandee @
BCooper@HumboldtBank.com
or FAX
24 hours per day, 7 days per week to Artistic! Financial Services:
1-866-RTISTIC! (1-866-784-7842) FAX
©2002-2003, Artistic! Financial Services; All Rights Reserved.