Merchant Information Sheet

To: Julio Tirado

Ph: 877-457-2615 Opt# 1 Ext: 2701066
Fax back # 1-877-505-7817
Direct Phone: : 770-303-1552
Julio.tirado@firstdata.com
Doing business name (as it will print on your customers receipts)
D/B/A _____Regency Travel & Tours__________________________________
Business Legal Name: (Tax filing Name)
_____________________Regency Travel & Tours ________________________
Physical Business Address: _Suhaim Bin Hamad Street ________Suit#___________
City: __________Doha___________State: __QATAR_______

Zip: P.O Box 9012

Business Phone: ___44344444_________ Fax #: ___44478296____________

Contact Name: __Rafik Ahmad________________ Alternate phone #: _____44344700___
Business start date: ___01/09/1986__

Number of Employees: __400 +___

How soon are you looking to get started: _____________Immediately _________________

Type of Products/Services Sold / provided: __Travel Specific (Air/Hotel/Cars/Insurance)
Credit Card machine make & model: _____ N/A______________________________
Circle One: Sole Ownership Partnership Public Corp

Private Corp

Non-Profit

Govt. LLC

(All sales, cash, credit cards Etc.

Annual Gross Sales: $___1 billion _____ Annual MC/VISA Sales $_____82 millon_______
AVG Ticket: $___600________

High Ticket: $____10000________

Federal Tax ID (EIN#): ________________________ State Incorporated: ___________

Owner/Signor Information:
Print: First Name Middle Initial and last name
(Signor/Officers Legal Name): ____Tareq Abdullatif Taha_____Title: __CEO______
Social Security# _______-__________-__________ % of ownership__________

Provide signors home address and Phone number, for verification purpose
Home Address: Suhaim Bin Hamad Street City:___Doha_____State:___Qatar______
Zip: P.O box 9012

Home Phone: __________________DOB: __22-09-1963___

Bank Reference: Include copy of Business check VOID

Bank Name: _________________________________
Phone: ____________
Contact name at Bank: _______________________________
Business Internet Info:
E-Mail:___________________________________Website:_______________________
Delivery Time from the time of purchase
% of Orders/Services delivered in 0-7 days: _____% 8-14 days: _____% 30 days: ______%
% Of Business To Business:______________

% Of Business To Consumer:______________

TAPE BUSINESS CHECK HERE (VOID)

Bank Name: ________________________
Routing #: __________________________
Bank Account #: ___________________
FAX OR E-MAIL THIS FORMS BACK WITH COPY OF BUSINESS CHECK (VOID)
BUISNESS CHECK NUST HAVE THE BUSINESS NAME ON CHECK