Harley Financial Services
Information Request Form

Any information provided to Harley Financial Services will be treated as if it were our own! You will never have to worry about Harley Financial Services or PaymentStuff.com providing, sharing, or selling any part of your information to any other party.

Upon submitting the following form, Harley Financial Services will provide you with a written proposal within 2 business days!

Proposals only available for companies located and processing within the United States of America.

Company Name
Contact Name
Street Address
City State Zip
Phone Number Fax
E-mail Address
Type of ownership
Years in business
Do you currently accept credit cards?
Are you interested in a Custom Gift or Loyalty card program?

If yes, what is your previous 12 months volume in Visa and MasterCard charges?

What is your average sale? (in Dollars)
Terminal model or Software used for Visa/MasterCard
(i.e. Tranz 330, Hypercom T7P, IC Verify, etc)
What do you sell?

How do you sell your products? (Please enter percentage for each)
Retail (card-present) %
Mail/Phone/Catalog %
Internet %
Other %
Please Explain

How would you like us to provide you with your formal proposal?
Is there anything else we should know about your particular business or operations that would impact the accuracy of our proposal?




Harley Financial Services
5616 S 122nd E Ave, Suite N
Tulsa OK 74146

Harley financial Services is a registered ISO/MSP with Citizens Bank NA, Providence, RI