BPICinc

Thanks for visiting my site!

Your comments are appreciated!

Just complete this form. Click on Submit when ready to send.

Each website that you purchase reguires a unique domain name such as

www.myname.com .If you do not already own a domain name, we can reqister your

domain name for $50.00 (covers two years). This is $20 less than the standard fee.

Yes, reqister my name. I have checked availability of the name.

No, I already own a domain name and am transfering it here.

Domain Name	Do not include www in your name, it will be added automatically.
Login	(must start with a letter, 4-8 characters)
Plan Type
Special Instructions (additional to register etc)
	Subscriber Information (All Fields Required)
First Name
Last Name
Company Name
Address
City
State
Zip/Postal Code
Phone
Fax (optional)
E-mail

Send Payment

If you require a Merchant Account/Gateway Account through Total Merchant Services fill out form below:

(fill out as much as possible)

For questions on TMS services, you my contact the following representive:

Mark Sandos-1-888-730-8229

Your Name:	Title:
Phone:	Fax:
Your e-mail:
Legal Business Name:	DBA:
Business Address:	Licensed In:
Address Line 2:	Suite:
City,Zip:	State:
Describe Business:	# of Locations:
Fed Tax ID:	% Mail Order:
State Tax ID:	% Phone Order:
Business Hours:	% Trade Show:
Type of Business:	Age of Business:yrsmo.
Date Acquired:	Year Started:
Est. Monthly C/C Sales:	Est. Average C/C Sales:
Business Location Type:	Refered By: (Leave as is:)
Please Rank your Credit:	Type of Gateway Account Needed:
Payment Terms for Virtual Terminal Software
Comments or Special Requests:	Thank You, Total Merchant Services Will Contact you within 72 Hours.