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2CP USA ONLINE PRE-APPLICATION (Note: Items in red are required)
Please tell us about your business:
First Name
Last Name
Business Name
Business Address
City
State (U.S. Only)	Select a State Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Work Phone	XXX-XXX-XXXX
Fax	XXX-XXX-XXXX
Mobile Phone	XXX-XXX-XXXX
Best Time to Call
Website Address (If any)
Email Address
Please tell us about how you will be accepting credit cards:
Type of Business	Apparel Banking Biotechnology Chemicals Communications Construction Consulting Education Electronics Energy Engineering Entertainment Environmental Finance Food & Beverage Government Healthcare Hospitality Insurance Machinery Manufacturing Media Not For Profit Other Recreation Retail Shipping Technology Telecommunications Transportation Utilities
Length of Ownership	Length of Business Ownership New Business - Less than 30 Days Less than 6 Months 6 Months - 1 Year Less than 2 Years Less than 3 Years 3 or More Years
Type of Merchant	--None-- Retail/Card Swipe Mail Order/Phone Order Internet/Shopping Cart
Equipment/Software Needs	Equipment Software Needs Credit Card Terminal - No Printer Terminal with Thermal Printer Terminal and PinPad Terminal and Check Reader Terminal, PinPad, & Check Reader Transaction Manager Software Cellular Credit Card Terminal Internet Payment Gateway
Average Ticket Size	Average Ticket Size $100 or Less $100 - $500 $500 - $750 $750 - $1000 $1000 or More
Average Monthly Volume	Projected Monthly Credit Card Volume Less than $5,000 Volume $5,000 - $10,000 Volume $10,000 - $25,000 Volume $25,000 - $50,000 Volume $50,000 - $100,000 Volume $100,000 & More Volume

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