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MERCHANT INQUIRY FORM Business Type Business Name Your Name City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code E-mail Address Daytime Phone Evening Phone I'm interested in knowing more about...   How did you hear about Care Swipe?   My current card processor is... (if any) ABOUT US View how we bill our merchants! Sample Merchant Statement (PDF, 37 KB) LOCAL MERCHANTS Fitness Defined   www.FitnessDefinedAZ.com Tom Crawford Leadership Foundation   www.tclcf.org R & R Auto Glass   www.New-Windshield.com Mesa Defense Firm   www.MesaDefenseFirm.com FREQUENTLY ASKED QUESTIONS What can you do if we are in a contract with our current credit/debit card processor? Care Swipe will pay the termination fee if your current processor charges one. It's Simple! Just fax us your bank statement showing the deduction for the termination fee and we will credit your account the fee. Now it is simple to switch to Care Swipe. When are our fees taken out? The fees associated with the % discount are taken out at the end of the month along with the monthly fees. CORPORATE ADDRESS: Care Swipe 610 N. Gilbert Road Ste. 104 Gilbert, AZ 85234 Telephone:  877-431-0727

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