RETEX and Cricket Hill Associates have partnered to provide RETEX members with a superior Prepaid Payroll MasterCard® product that offers cardholders easy access to their deposit accounts via ATMs, POS terminals, retail locations and the Internet.

Fill out the information below and a Cricket Hill Representative will contact you shortly to discuss your needs.

Merchant Contact Information

Merchant Name (DBA):
Business Physical Address:
Business City / Town:
Business State, ZIP:	,
Service / Products:
Contact Person:
Business Phone:
Business Fax:
E-mail Address:
Are you currently a RETEX Member?	Yes No
If yes, please enter your member number;

Business Profile

Business Structure:	Sole Ownership Partnership Corporation LLC
Merchant Type:	Choose Merchant Type Retail Restaurant Lodging Car Rental Other
Does the Business currently use debit cards?	Choose One Yes No
If "yes", for how long?	Years
What is the nature of the funds to be distributed?	Choose One Payroll Other
Additional Comments:

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