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Merchant Processing Quick Quote

CONFIDENTIAL

MichiCare has joined forces with the Michigan Retailers Association in an exclusive arrangement to provide you with the lowest possible merchant processing costs. Find out how much you can save by completing this confidential Quick Quote form.

For a confidential quote and review of your program, please submit 1-2 months’ processing statements. We will analyze your costs and review your projected savings.

All information is confidential and will not be shared with anyone else.

Company name

Street address

City

State/Region

Postal Code

Contact Person*

Phone number*

Email*

Years in Business

Number of Locations

Annual Merchant Processing Volume $

Average Ticket $

# of Transactions Per Month

Types of Terminals

Dial Terminal (plugs into phone line)

Internet Terminal (plugs into your computer)

POS System

Other

POS or Other System Name:

Are your merchant terminals integrated with your POS system?

Yes

1-2 month's processing statements

Program administered by Michigan Retailers Services, Inc., a registered Independent Sales Organization for Synovus Bank, Columbus, GA.

Michigan Retailers Services, Inc. is a member in good standing of the Electronic Transactions Association.