Merchant Sign-Up Form

First Last Name (required):

Company Name (required):

Your E-mail (required):

Phone Number (required):

Website Address:

IBOA Code# (required):

Contact Me Via: (Choose One)

Best Time to Contact: (Choose One)

Monthly Volume? (Choose One)

Does your business currently accept credit cards?

When would you like to implement a new payment solution?

Additional comments or questions:

For Questions or More Information

Contact: I.P. HUNT FOUNDATION
6655 West Sahara Avenue , Suite B-200
Las Vegas, NV 89146

(702) 262-9701 * (877) 863-6756

IBOA@iphuntfoundation.org

The Independent Business Owners Assistance (IBOA) program is sponsored by the I.P. Hunt Foundation,a 501(c)(3) nonprofit community improvement and education charity.

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