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Form Submission
Jeremy Lessaris
2023-08-29T12:01:02+00:00
Arbitration & Claim Submission Form
Contact Info
Company
(Required)
Industry
Website
Name
First
Last
Phone
Email
Credit Card Processing Info
Do you currently have an active account?
Yes
No
How long have you been processing for?
What company are you processing with?
Current processor?
FiServ / FirstData / CardConnect
Global Payments
Elavon
TSYS
PayPal
Have you ever had a processor terminate your account?
Yes
No
Reason for termination?
How do you accept payments
Our Website / Ecommerce
In-Store Physical Terminal
In-Store POS System
Mobile Phone / Device
3rd Party Software
Invoicing System
Over the Phone
Other
Describe your payment acceptance process
What software, system or hardware do you use to process credit card?
What payment do you currently accept?
Visa / MasterCard
American Express
Debit / PIN
Discover
WEX
Diners Club
PayPal
eCheck / ACH
Other
Financials
What is the total company revenue?
This should include all sales including those outside of credit card processing
What is the total processing revenue?
Average credit card transaction size
Highest credit card transaction size
Estimated monthly volume average
Is your business seasonal?
Yes
No
What are your highest volume month(s)?
Contract & Statements
Upload a copy of your contract and most recent statements
Drop files here or
Select files
Max. file size: 50 MB.
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