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<p><b>COMPLETE CREDIT CARD PROCESSING SYSTEMS FOR YOUR BUSINESS. INTERNET -  HOME
Free Information, No Risk, 100% confidential.<br>
<p align="center"><b><font face="Times New Roman" size="5" color="#CC0000">Everyone Approved!</font></b></p>
<p><b><font face="Times New Roman"> Good Credit or Bad!&nbsp; To apply today, please fill out
contains all the information we need to get your account approved. For area's
that do not apply to you please put &quot;n/a&quot; in the box.<br>
documents necessary to establish your Merchant Account. Once returned we can
have your account approved within 24 hours.<br>&nbsp;</font></b>
<td align="center" bgColor="#990000" width="119"><b><font color="#ffff00" face="Arial,Helvetica" size="3">Service</font></b></td>
<td align="center" bgColor="#990000" width="160"><b><font color="#ffff00" face="Arial,Helvetica" size="3">Industry
<p align="center"><b><font color="#ffff00" face="Arial,Helvetica" size="3">US</font></b></p>
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Site
<td width="66"><b><font color="#3333ff" face="Arial,Helvetica" size="2">FREE</font></b></td>
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Shipping</font></b></td>
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Warranty</font></b></td>
<td align="middle" width="160"><b><font size="2">$10 Per Month</font></b></td>
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Sales
<td align="middle" width="160"><b><font size="2">$10 - $50&nbsp;</font></b></td>
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Fraud
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Amex Set
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">24 Hour&nbsp;Help
<td align="middle" width="160"><b><font size="2">$10 Month</font></b></td>
<td bgColor="#ffff00" width="119"><b><font face="Arial,Helvetica" size="2">Security
<td width="66"><b><font color="#3333ff" face="Arial,Helvetica" size="2">NONE</font></b></td>
<p><font face="Arial,Helvetica" size="2"><b>This is a <font color="#3333ff">No
Obligation Qualification Form</font> and is your first step to<font color="#cc0000">
accepting credit cards.</font> By filling out this form you will <font color="#3333ff">&quot;not
enter&quot;</font> in to any <font color="#006600">obligations or
contracts </font>with us. We will use it to determine the best program
to offer you based on the information you provide. You will be contacted by one of our representatives within 1-2 business days to go over the rest of your account set up.</b></font>
<p align="center"><font face="Arial,Helvetica" size="2"><b><font color="#cc0000">Note:</font>&nbsp;
All Information Provided To Us <font color="#cc0000">Will Remain 100%
<p align="center"><b><font color="#000099" face="arial" size="+2">Apply
<p align="center"><b><i><font size="2" color="#CC0000">Please fill out the
express application form completely.<br>Incomplete information may prevent us from properly
<td width="61%" align="right"><font size="2"><b>Your Full Email Address:</b><br>
<font color="#ff0000">be sure to use your full address </font>(i.e.<font color="#ff0000">
<td width="39%" align="center"><input type="text" name="user_email" size="29"></td>
<td width="61%" align="right"><b><font size="2">Your Name:</font></b></td>
<td width="39%" align="center"><input type="text" name="Applicant_Name" size="29"></td>
<td width="61%" align="right"><b><font size="2">Business Name:</font></b></td>
<td width="39%" align="center"><input type="text" name="Business_Name" size="29"></td>
<td width="61%" align="right"><b><font size="2">Business Phone Number:</font></b></td>
<td width="39%" align="center"><input type="text" name="Business_Phone" size="29"></td>
<td width="61%" align="right"><b><font size="2">Home Phone Number:</font></b></td>
<td width="39%" align="center"><input type="text" name="HomePhone" size="29"></td>
<td width="61%" align="right"><b><font size="2">Type of Business:</font></b></td>
<td width="12%" align="center"><input type="radio" value="retail" name="Type_Business"></td>
<td width="12%" align="center"><input type="radio" value="mailorder" name="Type_Business"></td>
<td width="88%"><font size="2"><b>Mail Order Business</b></font></td>
<td width="12%" align="center"><input type="radio" value="internet" name="Type_Business"></td>
<td width="88%"><font size="2"><b>Internet Based Business</b></font></td>
<td width="61%" align="right"><b><font size="2">Personal Credit Rating:</font></b></td>
<td width="12%" align="center"><input type="radio" value="excellent" name="Credit_Rank"></td>
<td width="12%" align="center"><input type="radio" value="good" name="Credit_Rank"></td>
<td width="12%" align="center"><input type="radio" value="fair" name="Credit_Rank"></td>
<td width="12%" align="center"><input type="radio" value="poor" name="Credit_Rank"></td>
<td width="61%" align="right"><b><font size="2">How Soon Would You Like a Merchant
<p align="center"><input type="text" name="How_Soon" size="29"></p>
<p align="center"><input type="submit" value="Submit" name="B1"></td>
<table border="3" cellspacing="0" width="85%" bgcolor="#E8E8E8" bordercolor="#C0C0C0">
<td width="100%" bgcolor="#E8E8E8"><font size="2"><b>Your information is confidential, it will not be sold or used for any other purpose, and you are under no obligation.
Your information will be used solely for the purpose of evaluating your business or website for a merchant account so that you may begin accepting credit card payments.</b></font>