Axia - Request Information

The final step in our simple 3 Step process is to fill out our Rate Proposal Request form below so that we may provide you with a Rate Proposal.

* Required information

Personal Information
Referred By:
Business:*
Phone:*
E-Mail:*
Contact Name: *
Contact Title: *

Company Information
Number of Sites:*

Type of Business (goods or services provided):*

Who is your current credit card processor?*


Satisfaction Level with Specific Areas
Pricing and charges?


Rates and fees
What is your qualified V/MC rate?

What is your keyed (mid-qualified) V/MC rate?

What is your business/commercial V/MC rate?

What is your standard (non qualified) V/MC rate?

What is your international V/MC rate?

What are your T&E transaction fees?


System Information
Do you use credit card terminals or a POS system?*
Credit card terminal POS system
Make/model of terminals or POS system*

How many terminals?

Make/model of printers:*

How many Printers?

Do you own, rent or lease this equipment?*
rent own lease
If POS system, name and phone number of provider:
Name:
Phone:

When you receive Merchant Services' Rate Proposal, we hope that you review and compare it to your existing service or other potential services. However, at Axia, we know it can be a confusing process to accurately compare various merchant transaction services. We have provided two documents below that can serve as tools to assist in truly evaluating services by the same criteria. You will need Adobe Acrobat Reader to view the file (Download Acrobat Reader from Adobe's web site).

Questions for Cost Comparison

Comparison Worksheet