Executive One Alaska - Trade Managment Service

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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 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. For your privacy and security, your account information is kept safe with the highest grade of commercially avaiable encryption. Your information will be kept completely confidential and will not be shared with anyone under any circumstances. Company Information Owner's Name: Mr. Ms. Dr. First: Last: Type of Ownership: Ownership Percentage: % Is This a Home-Based Business? Date of Birth (MM/DD/YY): / / 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 States Other If Outside the USA, Please Enter Country Here: If home address is the same as business address, click this box: Home Address: Suite or Apartment # If Applicable City: State: ZIP: Country: Home Phone Number: ( ) - Business Phone Number: ( ) - Best Phone Number To Reach Applicant: ( ) - Fax Number: ( ) - Your Email Address: Your World Wide Web Address (If Applicable): Credit 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, If You Remember, Where Did You Hear About Charge.Com? Please Feel Free to Send Us Any Comments You May Have: By Federal Law, All Information Provided Will Remain Confidential