MEGA M Application | netserviceportal.com

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MEGA M Application

Business Information

Client's Business Name (Doing Business As):

Business Address:

City:

State:

ZIP:

Location Phone #:

Location Fax #:

Business E-mail or Website Address:

Client's Corporate/Legal Name (Use Also For Headquarter's Information):

Billing Address(if Different Than Location Address):

City:

State:

ZIP:

Contact Name:

Contact Fax # / E-mail Address:

Contact Phone #:

Send Retrieval Requests to:

Business Location

Corp/Legal Location

Send Merchant Monthly Statement to:

Business Location

Corp/Legal Location

Individual/Sole Proprietorship:

Individual/Sole Proprietorship

State in witch Certificate of Assumed Name Filed:

State:

Corporation Chapter S,C:

Corporation Chapter S,C

State:

Medical or Legal Corportation:

Medical or Legal Corportation

State:

TAX EXEPMT ORGANIZATION (501C):

TAX EXEPMT ORGANIZATION (501C)

State:

INTERNATIONAL OGRANIZATION:

INTERNATIONAL OGRANIZATION

Location Filed:

ASSOCIATION/ESTATE/TRUST:

ASSOCIATION/ESTATE/TRUST

State Filed:

GOVERNMENT(Federal, State, Local):

GOVERNMENT(Federal, State, Local)

LIMITED LIABILITY COMPANY:

LIMITED LIABILITY COMPANY

State Filed:

PARTNERSHIP:

PARTNERSHIP

State Filed:

FEDERAL TAX ID #:

Detailed Explanation of Type of Merchandise, Products or Services Sold:

Additional credit/site survey information - all merchants

1. Zone:

Business District

Industrial

Residential

3. How many employees:

4. How many registers/Terminals:

5. Is proper licence visible?:

Yes

No

If NO explain:

6. Where is the merchant name displayed at the site?:

Window

Door

Store Front

7. Merchant Occupies:

Ground Floor

Other

if Other explain:

8. # of Floors/Levels:

1

2-4

5-10

11+

9. Remaining Floor(s) Occupied by:

Resedential

Commertial

Combination

10. Approximate Square Footage:

0-250

251-500

501-2,000

2,001 plus

11. Are customers required to leave a deposit?:

No

Yes

If YES, % of deposit required: %

12. Return Policy:

Full Refund

Exchange Only

None

13. Do you have a refund policy for MC/Visa/Discover Network/Amer. Express OnePoint Sales?:

Yes

No

If YES check one:

Exchange

Store Credit

MC/Visa/Discover Network Credit

American Express OnePoint Credit

If MC/Visa/Discover Network/American Express OnePoint Credit, within how many days do you submit credit transactions?:

0-3

4-7

8-14

Over 14

Mail/Telephone Order/Business/Internet Information
2. What % of bankcard sales represent business to business (vs business to consumer): Business to Business: % + Business to Consumer: % = 100% (total sales) 3. What is the time frame from transaction to delivery?(% of orders delivered in): 0-7 days: % + 8-14 days: % + 15-30 days: % + over 30 days: % = 100% 4. MC/Visa/Discover Network/American Express OnePoint sales are deposited (check one) Date deposited: Date of order Date of delivery Other Specify other:

Owners/Partners/Oficers
Owner/Partner/Officer 1 Name (First, MI, Last): % Ownership: Title: Home Address (No P.O. Box): Telephone #: City: State: Social Security #: ZIP: D.O.B: DI #: State:	Owner/Partner/Officer 2 Name (First, MI, Last): % Ownership: Title: Home Address (No P.O. Box): Telephone #: City: State: Social Security #: ZIP: D.O.B: DI #: State:

Settlement Information

Deposit Bank:

Transit/ABA:

Bank contact:

Deposit Account #:

American Express merchant account

Are you existing AMEX merchant:

Yes

No

If yes, AMEX #:

Strategic Alliance:
Building Tomorrow's Web Solutions - Today.
NetServicePortal forged a strategic alliance with Marenzana Group to leverage the collective team's focus and experience with technology solutions and the workplace …