Reseller Inquiry

First Name*

Last Name*

Phone Number*

Email*

Verify Email*

Job Title*

Company*

Street 1*

Street 2

City*

State*

Zip Code*

Credit Card Processor(s)

# of Merchants activated with Credit Card services monthly

Check and ACH processor

# of Merchants activated with Check and ACH services monthly

# of Sales Agents

# of Sales Offices

National Presence?
YesNo

Regional Presence?
YesNo

Primary POS Terminals

Other Virtual Terminals/Gateways

Inquiring about
Check and ACH processingBank Card Processing

How did you hear about Paya Services?