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Thank you for your referral!

Partnering with Paya process:
  • Complete form below and submit
  • Relationship Manager will contact you within 48 hours
  • Agreement and buy rate pricing will be forwarded to you

Contact Information


Current Processing Information (Optional)

# of Merchants activated with Credit Card services monthly

# of Merchants activated with Check and ACH services monthly

Information About Your Company Needs (Optional)

Inquiring about
Check and ACH processingGift & Loyalty Card ProcessingBank Card Processing

Additional Questions/Comments (Optional)