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                                                            [ Subscriber Merchant Logo Banner ]

First Name: Last Name:

Street Address 1:  

Street Address 1:

City:      State:      Zip Code:

Telephone:

E-Mail Address:


ORDER FORM

SELECTION. SERVICE DESCRIPTION PRICE
BANK FEE Non-refundable Merchant Account Application Analysis and Credit Approval Fee. $ 50.00 @

SECURE INTERNET

CREDIT CARD GATEWAY SETUP FEE

 Secure Internet Credit Card Merchant Account Gateway Setup Fee

$200.00@
BANK FEE Automated Clearing House (ACH) / Electronic Funds Transfer (EFT) Originator Merchant Account Setup Fee $100.00@
SECURE INTERNET eCHECK GATEWAY SETUP FEE Secure Internet Credit Card Merchant Account Gateway Setup Fee $295.00@
WEB SITE HOSTING FEE Setup Commercial Web Site URL Domain Name Hosting 50MB   $30.00@
DYNAMICALLY GENERATEDWEB ORDER SYSTEM HOSTING SETUP FEE Dynamically Generated Web Order System Hosting Setup Fee $160.00@
SECURE INTERNET CREDIT CARD GATEWAY ROUTING, TRACKING, REPORTING SERVICE TRANSACTION FEES   $  0.25@
SECURE INTERNET eCHECK TM GATEWAY ROUTING, TRACKING, REPORTING SERVICE TRANSACTION FEES $  0.75 @

[ THIS IS A FREE  DEMONSTRATION.    THERE IS NO CHARGE OR FEE FOR THIS DEMO ]


NOTICE: ANY ATTEMPTS TO CHANGE THE ORDER INFORMATION OR TO BACK-UP WILL RESULT IN AN ERROR MESSAGE. IN THE EVENT OF AN ERROR, RETURN TO http://www.emoney.net/emoney.html  REFRESH/RELOAD AND THEN CONTINUE

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