Merchant Quote Request
Fill out the form, upload their processing statement(s), and then call your National Sales Manager to generate a quote.
Contact Name
Business Name
Business Phone Number
Contact Email
example@example.com
Contact Cell Phone #
Are there any other decision-makers for this kind of thing?
Yes
No
Name of the other decision-maker
Who do you currently process with?
For how long?
How much do they charge?
What is your average monthly sales volume?
What is your average Ticket Sale?
What percentage of your transactions are Chip/Swipe (in store payments)?
What percentage of your transactions are keyed-in payments?
What percentage of your transactions are phone orders?
What percentage of your transactions are online?
Do you charge your customers a processing fee?
Yes
No
If you do charge a fee, what percentage? (leave blank if no)
Make and Model of your current POS and/or terminal
If you have both a terminal and a POS, are they integrated?
Yes
No
Does your terminal have a pin pad?
Yes
No
Do you own or lease your current equipment?
If there is a lease, how much is it per month?
How many more payments left total?
Which of the following features are you interested in?
e-Invoicing
Text-to-Pay
Advanced Fraud Alert (Prevent chargebacks before they happen)
ACH Transactions
Quickbooks Integration
Hosted Payments Page (taking payments on their website or app)
Customer Vault (for subscriptions & rebilling)
Lead Source
Where did this lead come from?
Notes
Follow up date
/
Month
/
Day
Year
Date
Appointment Time
Upload their Processing Statement(s)
If you have multiple statements, upload them all before clicking "Submit"
File Upload
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