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DATE:
BUSINESS NAME:
CONTACT:
PHONE NUMBER:
ADDRESS:
CITY:
STATE:
ZIP CODE:
DO THEY PAY FEES:
YES
NO
MONTHLY PROCESSING:
NOT SURE
UNDER $5,000
$5,000-$10,000
$10,001-$20,000
$20,001-$30,000
$30,001-$40,000
$40,001-$50,000
OVER $50,000
NOTES:
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MERCHANT SOURCE POS
P.O. Box 22, Levittown, NY 11756
PORTAL
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