Intake form

Help us serve you better

Name *

Email address *

Business name *

Address *

Phone number *

Business type *

Url *

Estimated monthly sales *

Desired payment methods *

Please select at least one option.

Credit Card

Debit Card

ACH Transfer

Mobile Payments

Current merchant provider

Comments or questions *

Additional questions or comments

Bank Statement 1 *

Bank Statement 2 *

Bank Statement 3 *

Processing Statement

Select *

Voided Check *

Select *

Please select at least one option.

Shona Riggs

Kevin Thomas

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