Merchant Account Pre-Application

Off-Line Version

To get started, fill out this pre-application and fax it or mail it to Breakthrough Consulting, along with a check for $95, which will be credited towards the application fee. This fee is refunded to you if you are declined for any reason except for derogatory credit or lack of credit. If you fax a check, we will reproduce it and deposit it at our bank, Elmwood Bank in Racine, WI. You will receive it back as a cancelled check with your other checks. We request this fee in advance because we do not simply send out applications to people who are still searching for a better deal or comparing offers or who are not ready to get set up yet. Applications and postage cost us about $3 each. Since only 1 out of 10 people send applications back, it costs us about $30 in wasted expense for each merchant who applies. If you simply want an application and are not commited to signing up, send us $30 and we will send you a blank application. If you then want your $30 back, return the blank application to us.

When we receive this application, we will fill out a hard copy version and return it to you for your signature. When you send it back in, you would include the required supporting material, such as copies of any ads, brochures or fliers, or a print out of your existing or proposed web site, along with a photo of the outside of your home or business, showing the physical address. An inside photo showing your product, inventory or office set up is also required. Depending on the program you have selected, a copy of a business license or business name registration may be required.

Business Information

Legal Name of Business:


Business Start Date: _________    # Locations: ________

DBA Name:


Monthly $ Volume: $________    Average Ticket: $______

Physical Address:


Type of Business: __ Retail,  __ Mail Order, __ Service

City, State, Zip:

 Product or Service Sold:

 Contact Name:


Card Present: _____ % of the time.  Not Present: ____ %

Phone Number:

 Fax Number:

Owner Information


____ Sole Prop  ____ Partnership


____ Corp  ____ Other: ____________

Tax ID # (Can use SSN):

Owner 1/Partner/Officer Name:

Title in Business:

Social Security #:

Home Address:

City/St/Zip:

Phone Number:

Owner 2/Partner/Officer Name:

Title in Business:

Social Security #:

Home Address:

City/St/Zip:

Phone Number:

Bank & Trade Reference Information

Bank Name:

Contact:

Phone Number:

Account #:

Trade Reference:

Contact:

Phone Number:

Account #:

Trade Reference:

Contact:

Phone Number:

Account #:

Trade Reference:

Contact:

Phone Number:

Account #:

Fee Schedule Information

Select the appropriate program from the information presented below:

Program 1
Process By Telephone - No Additional Equipment Necessary

Discount Rate: 2.69%   Transaction Fee: 50 cents   Monthly Min. Fee: $20   Statement Fee: $12

Set Up Fee: $295, incudes the $95 application fee paid with this pre-application. Upon approval, you will receive instructions on how to use the phone process method. No equipment is needed. Address verification is supported on this system. This program is for tangible products only, not services. This service is provided by MCCS, an agent for Woodforest Bank, Houston TX. Member FDIC

Program 2 - Our Best Value, Most Popular Program
 $5 Monthly Statement Fee, $20 Monthly Minimum Fee

Card Swiped Discount Rate (Non-Computers): 1.69%         Transaction Charge: 20 cents
Card Swiped Discount Rate (Computers): 1.89%                 Transaction Charge: 20 cents

A 1% keyed-in surcharge applies to the above discount rates.

Mail/Phone Order Discount Rate (Non-Computers): 2.49%    Transaction Charge: 30 cents
Mail/Phone Order Discount Rate (Computers): 2.79%            Transaction Charge: 30 cents

This program requires good personal credit (no excessive chargeoffs of collection accounts). Credit problems due to medical bills or other unexpected emergencies are overlooked. Depending on credit and type of business, processing bank my require copies of last year's tax return and three month's most recent checking account statements, to verify that you have an income outside of credit card sales.

Program 3 (Not Available At This Time)
 No Monthly Minimum Fee, $10 Monthly Statement Fee

Card Swiped Discount Rate (Non-Computers): 1.49%    Transaction Charge: 20 cents
Card Swiped Discount Rate (Computers): 1.69%            Transaction Charge: 20 cents

A 1% keyed-in surcharge applies to the above discount rates.

Mail/Phone Order Discount Rate (Non-Computers): 1.99%    Transaction Charge: 30 cents
Mail/Phone Order Discount Rate (Computers): 2.69%            Transaction Charge: 30 cents

A 7 day reserve account may be needed on new or mail order businesses. A $50 site inspection fee is also required. Property Resource Network will call you to set up an appointment to visit you to verify your business and take the needed photos.  This program requires a copy of a business license, a ficticious name registration or a copy of your certificate of incorporation. A business checking account and a copy of a Driver's License are also required.

Program 4 (Real-Time Processing Account - $450 Total Fee)

Discount Rate (Non-Computers): 2.69%                               Transaction Charge: 30 cents
Monthly Server Access Fee: $20                                         Monthly Minimum Billing Fee: $20
Monthly Statement / Customer Service Fee: $10                   Includes Shopping Cart w/ Virtual Terminal

Based on my business type and needs, I have selected Program ______.
My type of business is ___ Card Swiped, ____ Non-Card Swiped (select one).

Equipment Selection

EQUIPMENT TYPE

PURCHASE PRICE

24 MONTH LEASE

SUPPORTS AVS ?

POS Charge (PC Software)

$395

$27/month

Programs 2, 3 & 4

Mac Authorize (MAC Software)

$475

$29/month

Programs 2, 3 & 4

Verifone Zon XL

$395

$27/month

NO

Verifone Printer

$295

$18/month

N/A

Verifone Tranz 330

$495

$29/month

Programs 3 & 4

Verifone Tranz 380

$595

$34/month

Programs 2, 3 & 4

Verifone Tranz 460

$695

$39/month

Program 3 & 4

Verifone Tranz 420

$795

$44/month

Programs 3 & 4

Hypercom T7P

$695

$39/month

Programs 2, 3 & 4

Shopping Cart

$50 with Account

N/A

N/A

An optional 24 month lease is available instead of purchasing the equipment. The leasing company also charges your state sales tax rate plus a $2.50 per month loss and destruction waiver. Lease approval is based on your personal credit.

I have selected the following equipment: _____________________. I wish to ____ purchase, ____ lease it (select one).

I already have the following equipment: _____________________. I wish to have it reprogrammed for a fee of $150, in addition to the application fee.

Fax or Mail This Pre-Application Today!

I wish to apply for a merchant account based on the above information. I am enclosing a check made payable to Breakthrough Consulting for $95, which is refunded if my account is declined for any reason except for derogatory or lack of credit.

Signed: _______________________________

Date: ________________________________

Or, of course, you can pay by credit card!  We accept MC / Visa / AMEX

Credit Card #:________________________________

Expiration Date:_______________________________

Fax this paperwork and a check or credit card number to 414-639-5607. Given our high volume, our fax line is sometimes busy.  Please try again, or call (414-639-2270) so that we can clear the line.  Breakthrough Consulting maintainss a checking account at Elmwood Bank, Racine, WI. Faxed checks will be reprinted on our check printing system and deposited. You will get it back as a cancelled check.

You can also mail this package to:

Breakthrough Consulting
5335 Agatha Turn, Dept WCC
Racine, WI 53402

Or, for faster service, click on the Add To Your Shopping Basket button below.  You will be taken to Craftfinder.com's secure shopping service where you can pay online, or printout the form, and mail or fax it to us.  Don't forget to send us this application too!

Special Bonus Offers

1.  By applying through Breakthrough Consulting, you are entitled to one free search engine registration to over 250 search engines and directories. (A $95 value).

______ I wish to have my web page registered with over 250 search engines and directories at no cost. I have provided the following information:

Web Page URL: ________________________________________________________

Email Address: _______________________________________________________

Site Description: ______________________________________________________

____________________________________________________________________

6 Main Keywords:

1___________________   2____________________  3____________________

4___________________   5____________________  6____________________

Your site will be registered upon approval of your application

 

2.  By applying through Breakthrough Consulting, you are entitled to receive a $50 referral fee on each person you refer to us who is approved for a Merchant Account.  This option is free with Merchant Account Signup, or $75 (refunded upon receiving the 5th approved application from you)

_______  Yes, I would like to earn $50 referral fees.  Please send me more information.

Survey Time!

Please help us by answering these questions. Thanks.

What search engine did you use to find us? ___________________________

What search word or phrase did you use? ____________________________

Were you referred to us by anyone? If so, who? _______________________________________________________________

Thank you for completing this pre-application.  We will process it immediately and return a hard-copy application to you by mail.  As soon as you complete the final application, we will rush your application in for approval.

                                                       Sincerely,
                                                       Breakthrough Consulting

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Frequently Asked Questions

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Copyright (c)1997, 1998 by Breakthrough Consulting
5335 Agatha Turn, Dept CBT, Racine, WI 53402
262-554-0497 (phone), 262-554-8258 (fax)

 

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