Merchant Referral Form |  Check, ACH, Gift & Loyalty

Thank you for the Merchant Referral! We will contact the Merchant Referral on your behalf within 2 business days. We will price the Merchant Referral according to your previously provided referral pricing schedule. If you haven't provided us a schedule, we will use our descretion to price the Merchant Referral at a competitive rate. Thank you again for the referral!
Please fill out the following form and click the Submit button at the bottom of the page.

Merchant DBA Name:
Point of Contact:
Phone #:
Merchant Email:
Existing Processing Equipment:
Type of Business:

Desired Program(s):
Addtional Notes/Comments:

Merchant Service Provider: Paya ISO ID#:
Referring Agent:
Agent's email address:
Phone Number: City: State: