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How Should We Reach You?
Let us know the best way to contact you (and a few things about your practice) and one of our team members will be in touch within 1 business day. Can’t Wait? Call us at 855-818-2912
Practice Info
Practice Name
*
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Alternate Phone
Time Zone
*
(Select)
PT - Pacific
MT - Mountain
CT - Central
ET - Eastern
AT - Atlantic
Best Time to Contact
*
(Select)
8am - 10am
10am - 12pm
12pm - 2pm
2pm - 4pm
4pm - 6pm
Processing Information
Tell us a little bit about how you accept payments
Do you currently accept credit cards?
*
Yes
No
How many physical locations do you have?
*
(Select)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20+
Notes
Upload Statements
If you would like us to prepare a customized pricing analysis, please upload one to three months of prior processing statements.
Click "Choose Files" to browse for files on your computer or mobile device. Up to 12 files can be uploaded.
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