Credit Card Processing - Made Simple, Affordable, & Profitable - Trilogy Payment Solutions, LP

Trilogy Payment Solutions, based in Fort Worth, Texas, offers competitively priced merchant services.

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MERCHANT ACCOUNT PRE-APPLICATION FORM

Thank you for your interest in becoming a Trilogy merchant. To better understand your needs, we need
to ask you a few questions regarding your business. Complete the information below for a FREE no-obligation
account evaluation/proposal. We will call you as soon as possible once we receive your pre-application.
Please read Patriot Act Notification by clicking here Patriot Act. Please Note: This is NOT an application
for Credit Card processing; however, it will speed up the application process. Once we receive this form,
a sales representative will contact you to begin the application process.

Name of Business:

Type of Product or Service:

Contact Name:

Title:

Day time Phone:

Mobile Phone:

Business Address: (or home address if home based bus.)

City:

State:

Zip Code:

Email Address:

Business Fax:

How soon would you like to Set up your account?:

Does your business currently accept credit cards?:	Yes No

If Yes, what is the name of the processor?

What is your current (or anticipated) average credit card sale (in $):

What is your current (or anticipated) Monthly average Visa/MasterCard Volume (in $):

Current Discount Rate:

Current Transaction fee (in $):

If you would prefer to speak with a Trilogy representative directly, please call toll-free 1-800-609-7880. Trilogy representatives
are available to assist you Monday - Friday from 9 AM to 5 PM Central Standard Time. If you contact Trilogy after hours, please
leave a message and we will return your call the following business day. If you prefer to contact a Trilogy representative
via e-mail, click here.

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