Tell Us About Your Business

Name *

Business Name *

Address

Best Contact Number

Best Email Address *

Annual Revenues

Number of Locations

1-4

5+

Number of Employees

1-5

6-25

26-50

50+

Type of Technology

Point of Sale

Virtual Terminal

E-commerce

Counter Terminal

Integrated Pinpad

Is e-commerce a requirement?

Yes

No

Does your business ship products or charge more than 5 days in advance of a product or service being provided?

Yes

No

Current processing relationship?

Any chargebacks in 2021?

Yes

No

Best time to contact?

Please tell us a little about your business. If this is an emergency situation, please also indicate that so we can prioritize your situation. *

Subject *

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