Offshore Merchant Accounts

Offshore Financial
Freedom

Alternative Merchant Account
Application for Rate Quote Form

Offshore Financial Freedom, Inc. accepts applications from merchants for business located anywhere in the world. You may print out and fill form and fax to (928) 832-7700 at your convenience. However, the account will not be set up until the application fee has been received. To apply, please complete and submit the following form and remit application fee.

APPLICATION FEES ARE REFUNDABLE IF YOU ARE DECLINED!!

Thank you for considering Offshore Financial Freedom, Inc. for your Internet payment processing needs.

Contact Information

Title:

Given Name:

Middle Name:

Family Name:

E-mail address:

Business Information

Company name:

Business Physical Address:

Business City:

Business State / Province:

Business Zip or Postal Code:

Business Country:

Website Address:

Telephone Number:

Fax Number:

How long have you been in Business?

Detailed description of the goods or services sold:

Please select the currency which will apply to the following two questions:

What is the annual dollar volume to be processed by credit card ?
(Specific amount, not a range please)

What is average amount of each charge to be processed?

Anticipated maximum order value expected:

What Percentage of your sales are from:
(Total should equal 100%)

Internet:	%	Mail Order/Phone:	%
In Store:	%	Trade Show:	%
Service:	%	Other:	%

Which credit cards do you wish to accept?

	Visa		Discover
	American Express
	Master Card

Business Structured as...

If Other, please specify

Country of Incorporation:

Other country of incorporation (if not listed):

Date business started:

Ownership Information

Principal's Given Name:

Principal's Family Surname/Name:

Percentage of ownership:

Date of Birth: (mm/dd/yyyy)

Country of Citizenship:

Other country of citizenship (if not listed):

Home Phone Number:

Home Street Address:

City:

State/Provence:

Zip or Postal Code:

Country:

Other country (if not listed):

Please rate your credit history:

Any bankruptcies in the last 3 years?

Yes No

Where did you hear about us?

Pressing 'Apply Now' submits the form to us and takes you to the application charges in your shopping cart. Remember, the application fee is refundable if you are turned down.