Potential Referral Partner Form

1
What is your full name?* This field is required.
First Name
Last Name
2
What is your email address?* This field is required.
example@example.com
3
What is your phone number?* This field is required.
4
What is your title?* This field is required.
e.g. CEO, VP Sale, etc.
5
What is your company's name?* This field is required.
e.g. My Company Limited
6
What is your company's website address?* This field is required.
7
In which country are you based?* This field is required.
8
What merchant types do you work with?* This field is required.Please choose all relevant options
Please Select
Accommodation Services Provider
Accounting Services Provider
Adoption Agency
Adult Content Services Provider
Adult Physical Goods Seller
Advertising Services Provider
Airline
Alcohol Seller
Amusement/Recreation Services Provider
Animal/Animal Parts Seller
Appliance Cover Provider
Art Dealer
Auction House
Audio Licensing/Sound Bite Provider
Cannabis-Related Products Seller
Car Wash
Caterer
Charitable Organizations
Children's Classes Provider
Clothing and/or Fashion Accessories Store
Coin/Precious Metal Dealer
Company Formation Services
Computer Software Seller
Consultancy Services Provider
Consumer Electronics Seller
Contractors/Construction Company
Cosmetic/Beauty Product Seller
COVID-19 Test Laboratory
Cruise Line Operator
Cyber-Locker Services Provider
Dating Services Provider
Debt Collection/Management Services Provider
Discount/Promotion Code Reseller
Driving Instructor
E-Book Subscription Seller
E-Commerce Marketplace
E-Wallet Operator
Escort Services Provider
Event Organiser
Financial Skill Games Platform
Fireworks Seller
Food Stall/Truck Vendor
Furniture/Home Furnishing Seller
Gambling Operator
Hairdresser and/or Beauty Salon
Heating/Plumbing/AirCon Contractor
Hobby, Toy, and Game Shops
Immigration Services Provider
In-Game/Virtual Goods Platform Operator
Insurance Services Provider
Legal Services Provider
Logistics & Delivery Services
Lottery Messenger
Lottery Syndicate
Medical Services Provider
Mobile Phone Repair Services Provider
Money Remittance Services Provider
Mysticism /Divination Services Provider
NFT Marketplace
NFT Seller
Nootropics Seller
Nutraceutical Products Seller
Online Fan Engagement Platform Provider
Online Gambling Courses Provider
Online Gaming Platform Operator
Online News Outlet
Online Personal-Development Courses Provider
Online Professional Courses Provider
Online Trading Courses Provider
Payday Loans Provider
Personal Assistant/Concierge Services
Pet-Related Products Seller
Pharmaceuticals Seller
Photographer and/or Photographic Studio
Prize Competitions Operator
Professional Cleaning Services Provider
Proprietary Trading (PropTrading) Platform Operator
Psychedelics Seller
Real-Estate Broker
Restaurant
Securities Trading Operator
Sex-Dating Services Provider
Skill Games Operator
Smoking/Vaping Products Seller
Sporting Goods Store
Stock Image Seller
Supermarket/Grocery Store
Taxi/Limousine Operator
Technical Support Services Provider
Ticket Broker
Tour Operator
Travel Agency
Utilities/Telecommunications Services Provider
Vehicle Data Checking Service Provider
Vehicle Dealer/Seller
Vehicle Rental and/or Leasing Agent
Vehicle Repair Services Provider
Virtual Currency Exchange
Voucher/Gift Card Broker
Weapons Seller
Web Designer
Web Hosting Service Providers
Website Traffic Generator
9
Where are you merchants from?* This field is required.i.e. Incorporation Country
UK
EU
Other
10
Please tell us more about your businessAnything you believe might be relevant
Huge
Large
Normal
Small
Ok
Ok
11
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12
Form Source
13
Get Page URL
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