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First name

Last name

Email

Legal business name

Phone

DBA name

Enter URL

Processing Information

Anticipated monthly volume

Anticipated largest transaction amount

% of Goods Delivered in 8 to 14 days

Anticipated average transaction amount

% of Goods Delivered in 0 to 7 days

% of Goods Delivered in 15 to 30 days

% of Goods Delivered over 30 days

Current chargeback %

Detailed business description (including licences held if required)

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