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Existing Partner Form

Your Information

Prospect's Information

Prospect's Primary Contact Information

Merchant Type

Partner's Relationship With Prospect

Additional comments

Partner Lead Referral

Thank you for working with Shift4 to offer the industry’s most comprehensive payment gateway, DOLLARS ON THE NET®, to merchants across every industry in the U.S., Canada, and the Caribbean. Please send us your referral by completing and submitting the form below.

But First – Are You Ready For EMV?

If you haven’t already contacted us about EMV – now is the time to certify! Contact us today to get into development for your U.S. EMV certification.

Thank you again for stopping by to submit your referral for Shift4’s DOLLARS ON THE NET.

 
Shift4 * Indicates a required field
Please provide your company name and contact information.
*Company Name 
*First Name 
*Last Name 
*Title 
*Main Phone Number 
Mobile Phone Number 
*Email 
 
Shift4
Please enter the name and information for the prospect you are referring.
*Company Name 
*Address 
*City 
*State/Province 
*Postal Code 
*Country 
Website 
 
Shift4
Please enter the primary contact's information for the company you are referring.
*First Name 
*Last Name 
*Title 
*Main Phone Number 
Mobile Phone Number 
*Email 
 
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Tell us about your relationship with the company you are referring to Shift4.
*What POS/PMS system is used by the prospect that you are referring? 
Number of Locations 
Please check all merchant types that this prospect currently utilizes.
     Hospitality
     Food & Beverage
     Retail
     Mail Order/Telephone Order
     e-Commerce
     Auto Rental
     Other  
*What is your current relationship with the prospect? 
     Prospect is in an active sales process for my software. Contract
is expected to close on:
     Prospect is not currently using, but is contracted to use, my
software. Projected go-live date is:
     Prospect is already using my software. 
     Prospect is changing their version of my software, prior to Shift4
installation. Projected go-live date is:
Are any security peripheral devices being sold by you to prospect (e.g., SRED entry/swipe device,
PIN pads, etc.)?
   Yes    No
If yes, list equipment types.
Acquiring Bank
 
Shift4
* Verification Code:
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