Agent Inquiry Form

State

Select all the key products your business offers:* Check Cashing Currency Dealing or Exchange Issuer of Stored Value/Gift Cards Money Orders Money Transfer None of the above

Is your credit score 650 or above?* Yes No

Select the estimated monthly foot traffic at your location(s):*

Select each type of major biller you would like to process:* Local Utilities MasterCard/Visa Cellular Providers Prepaid Services Other

Do you have a PC at your location(s)?* Yes No

Are you able to make daily bank deposits?* Yes No

How did you hear about CheckFreePay?*

Are you currently processing bill payments?* Yes No

Agent Inquiry Form

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