| New Agent Application
Business Name___________________________________________________________________________________ DBA Name (if different)___________________________________________________________________________ Contact Name___________________________________________SS#(Required)_____________________________ Address_________________________________________________________________________________________ City/State/Zip_____________________________________________________________________________________ Home Phone____________________________________ Work Phone______________________________________ Fax______________________________________Email__________________________________________________ Description of Products and
Services_________________________________________________________________
Type of Business (be specific)_______________________________________________________________________
|
Mailing Information:
For Visa & MasterCard Processing, please mail or fax* this
application, with the agreement and a check to:
TeleCharge Texas - 019
450 N. Sam Houston Park Way, Suite 273
Houston, TX 77060
Attention: TeleCharge Agent Service - Chuck Taylor Sr. Account Rep.
Fax: 281-445-7257
*The original copy must
follow all faxed information.
Please call 800-948-6457 for all customer service questions. We look forward to servicing your business; and thank you for choosing TeleCharge the simple access to credit card processing!
TeleCharge, Inc.
Application
1/13/98
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