Please fill out the following form for your client.

A representative of SparkUpBiz Services will contact your client within 24 business hours.

We will copy you on initial emails and update you to as their deal status as we progress working with them.

Please understand that due to financial privacy & security, we will not copy you on anything that would put the client at risk.

Referring Bank Officer First Name *

Referring Bank Officer Last Name *

Referring Bank Officer's Phone Number *

Referring Bank Officer Email *

Branch Name *

Branch Phone Number *

Please tell us about your customer so we can help them to the best of our ability.

First Name *

Last Name *

Phone *

Email *

Services Requested by your client

What industry are they in?

If other, what is the nature of their business?

If they are in the peptide, medical, online pharmacy, or telehealth industries, are they LegitScript Certified? (We offer assistance with this at a discount we just need to know.)

Have they been turned down elsewhere? *

If they have been turned down, please state why to the best of your knowledge:

Are they on the TMF/Match list? *

Will they need a physical terminal or POS? *

One of the things we will require to start all payment processing applications is a voided business check (can not be a starter check), or a letter on bank letterhead stating the account information and that they are in good standing with the bank. In an effort to streamline the process for the client, please upload here.

Voided Business Check

PDF

Captcha

By submitting this form, I hereby authorize communication about this lead to be communicated to be via email and phone methods. I also agree to receive updates and market information and understand that I may unsubscribe at any time.

I have alerted the client that I will be receiving communication via phone calls and emails from SparkUpBiz Services and it's agents. They are aware that we are sharing this information with SparkUpBiz Services in an effort to provide them services.