The Lewis Financial Group
T.E.A.M.
Together Everyone Achieves More
INITIAL MERCHANT ACCOUNT APPLICATION

   Original hard-copies are required for the processing of your Merchant
Account Application. The following information is used to get the
appropriate Forms to you,  All slots with an  *  must be filled.  
  
First Name *
Last Name *
Business Name *
Business Address *
Business Address 2
City *
State/Province *
Postal/Zip Code *
Country *
Telephone Number *
Email Address *
Type Of Business *
Industry*
Average Monthly
Charges *
Under $5,000
Over   $5,000
Comments or
Questions

Last updated on:
November 8, 2006

You may rest assured that your information will not be sold, given nor released to anyone. Since we do NOT charge an application or Processing fee, we send you the appropriate Forms based on the information you provide.
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We are actively recruiting Sub-Agents.
Please indicate whether you have an interest and would like more details.
Yes

  Russell G. Lewis
(443)622-0561
No


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