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POSiPayments Leads
Office Name or Office Code *
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Person Submitting Lead *
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Phone Number of Person Submitting Lead *
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Business Name *
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Owner Name
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Owner Phone #
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Owner Email Address
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Primary Contact (if other than owner)
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Primary Contact Phone #
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Primary Contact Email
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Do you currently earn credit card residuals for this merchant? *
If you do earn credit card residuals, how much?
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Type of Deal *
Does the merchant currently accept gift cards? *
If the merchant accepts gift cards, who do they use?
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Should we contact you to discuss this lead? *
Are you charging a monthly support fee? *
If Yes, how much? *
Your answer
Have you submitted a statement? *
If NO, how will you be submitting? *
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