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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 Payments to offer your merchants the industry’s most secure and comprehensive payment gateway and complete merchant services. We value our partnership and we’re grateful for your interest in sending more business our way.

Get Started

Through our merchant services offering, your merchants can receive unparalleled benefits, including:
  • The unmatched speed, security, reliability, and benefits of our secure payment gateway, including industry-leading EMV, tokenization, and point-to-point encryption solutions
  • Competitive merchant services and payment processing rates
  • Processor connection
  • World-class 24/7/365 customer service

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 to Shift4 Payments.

 
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Please provide your company name and contact information.
Office Code 
*Company Name 
*First Name 
*Last Name 
*Title 
*Main Phone Number 
Mobile Phone Number 
*Email 
 
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Please enter the name and information for the prospect you are referring.
*Company Name 
*Address 
*City 
*State/Province 
*Postal Code 
*Country 
Website 
 
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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 services is this lead interested in? 
Does prospect have existing POS/PMS system 
Yes No
If yes, what kind?
Number of Locations 
Number of Years in Business 
Please check all merchant types that this prospect currently utilizes.
     Hospitality
     Food & Beverage
     Retail
     Mail Order/Telephone Order
     E-Commerce
     Auto Rental
     Other  
*Average Ticket (estimated) 
Highest Ticket (estimated) 
Monthly Volume (estimated) 
*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
 
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* Verification Code:
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