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 can also setup your pos system.  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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Copyright © 2004-2010 Trilogy Payment Solutions, LP.  View our Privacy Policy and our Patriot Act Notification.