Platinum Merchant Services

ph: 512-291-0133
fax: 866-354-8168
alt: 512-791-5170
sales@bankmerchantbiz.com

Contact Us

Platinum Merchant Services

Merchant Referral Form

*Banking Center Name / Locale:

*Banking Center Employee Name:

Merchant Contact Name:

*Merchant Business Name:

Merchant Phone Number:

Merchant E-Mail Address:

Address Line 1:

Address Line 2:

City:

State/Province:

ZIP/Postal Code:

Does Merchant Currently Accept Credit Cards?

Yes No

What products / services is the Merchant most interested in learning about?

Comments:

Submit Your Message:

ph: 512-291-0133
fax: 866-354-8168
alt: 512-791-5170
sales@bankmerchantbiz.com