E-Check / ACH Processing Assessment

Thank you for considering Liberty Enterprises for your ACH / E-Check Payment Solution. The information you provide will allow us to assess your company as a potential customer. All information submitted will be kept completely confidential.

Fields marked with a (*) are required.

Contact Information

Company Name: *
Type of Business : *
Main Web URL Address: *
Contact Person: *
Contact Telephone Number:
(Please ensure you include the area code and that your number is correct) 		*
Hours of Contact:
Contact Email Address: *
Launch Date:

Transaction Information
Have you processed ACH before ? Yes No
If so, which company have you processed with?
For how long have you been processing with them?
(Expected) Monthly Amount Processed:
Expected Percentage of Credit Cards by Phone:
Expected Percentage of Credit Cards by Internet:

Other Information
Where did you hear about us?:
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