Merchant Form
Get More Information or Quote today.
Please fill out this form to get more information or sign up for one of our services today.
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Contact Information
Contact Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Service of Interest - Choose all that apply
Credit & Debit Card Processing
ACH & eCheck Processing
High-Risk Industry Processing
QuickRefund
Retail Financing
Payment Gateways & Virtual Terminals
Point of Sale (POS) Solutions
Mobile Payments
Recurring Billing & Subscription Management
Chargeback Management & FraudProtection
Gift & Loyalty Programs
Custom Integrations & API Access
Affiliate ID
Offer ID
_ef_transaction_id
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Business Information
Company Name
DBA Name (if any)
Industry
Incorporation State
Website
Business Contact Information
Public Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Public Email
example@example.com
Company Address of Operations
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Business Merchant Info
Current Merchant Services Provider
Expected Highest Monthly Sales Volume
Expected Highest Transaction Amount
Expected Average Transaction Amount
Your last 3 months credit card processing statements
Browse Files
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NEXT STEPS
Our team will take your information and build you a customised quote. Choose any of the following options that best fit your needs.
Quick Refund
After you submit this form you have two options : be taken directly to the Quick Refund fora a fast and easy set up process, or you can speak with a team member that can help answer any questions first.
Setup Options for Quick Refund
Setup Now - Go to on boarding process
Work with a Quick Refund Rep - Answer questions and activate service later
Credit Card Processing
After you submit this form you can be taken directly to the full merchant application. This is form needs to be completed to activate your processing. Select Setup Now to complete the merchant application and activate your services today.
Setup Processing Options
Setup Now - Go to the merchant application
Work with a Synergist Payments Rep - Answer questions and activate service later
Financing
After you submit this form you can be taken directly to the full merchant application. This is form needs to be completed to activate your processing. Select Setup Now to complete the merchant application and activate your services today.
Setup Financing Options
Setup Now - Go to the merchant finance application
Work with a Synergist Payments Rep - Answer questions and activate service later
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