SPS Customer Referral

CUSTOMER REFERRAL FORM

Customer Information

Business Name

First Name

Last Name

Email

Phone #

Accounting Software

Address Line 1

Address Line 2

Zip Code

City

State

Customer Interested In: (Select all that applies)

Complimentary Rate Comparison

QuickBooks Processing

Self-Service Payment Portal

Sage 50, 100, 200, 300, or 500 Processing

POS Software

New Payment Terminal

NetSuite

Mobile Payments

Custom Payment Page

Custom Payment Integration into ERP

New Business

ACH

Field Service

Other

Comments to Business Development Manager

Partner Information

Name of Referring Office

Partner First Name

Partner Last Name

Contact Phone

Email

Lead Source

Receive Automatic Email Lead Status Updates

Business Development Manager

Business Development Manager Email

SPS Account Manager

SPS Account Manager Email

Logo Image

Image URL

OR

Upload Image

Thank you for your referral. Your submission was successful. You will get an email confirmation shortly. If you do not receive our confirmation email within the next ten minutes, please check your spam inbox or contact your Business Development Manager.