Referral Partner Portal

Part 2

Please provide the following information about the lead you are submitting:

Company Name*

Key Contact First Name*

Key Contact Last Name*

Key Contact Title*

Key Contact Email*

Address*

Street Address Address Line 2 City State (if in U.S., please use 2-letter abbreviation.) ZIP / Postal Code Country

Phone*

Website URL

Preferred Method of Contact

Phone
Email

Currently Utilizing Electronic Payments?*

Yes
No

Estimated Annual Revenue*

Under $5 million
$5 - $25 million
$26 - $50 million
More than $50 million

Do you require a pre-call with a representative of Priority Commercial Payments before we make direct contact with the organization you are referring?*

Yes
No

Additional Notes

Join the Growing Payments Revolution

Step 1 of 2

PART 1:

Part 2