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Referrer Information
Referrer Name
*
First
Last
Referrer Phone Number
*
Referrer Email
*
Referrer i3 Verticals Division
*
Choose one
Axia Payments
Bill & Pay
CCP
Court Solutions
CSC
EMS
Fairway
i3 Verticals Agent
Infintech
Local Level
PaySchools
PlacePay
Practical Business Solutions
Randall
SDCR Esber
Other
If Other (selected above) - Please Explain
*
Prospect Information
Please include prospect name, email, phone number, & best time to contact.
Prospect Name
*
First
Last
Prospect Company
*
Prospect Email
*
Prospect Phone
*
Merchant Type
*
B2B
Government
Hospitality
Non-Profit
Restaurant
Retail
Software/Integration Partner
Other
If Other (selected above) - Please Explain
*
Solution(s) Desired
*
TranSafe
Bill & Pay
Court Solutions
i3 Integration Opportunity
Local Level
PaySchools
PlacePay
i3 Verticals POS (e.g. NCR, rPower, Clover)
mobileAxept
onePOS
Integration Platform
*
Select all that apply
Windows
iOS
Android
Monthly Processing Volume
*
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Under 25,000
25,001 - 50,000
50,001 - 100,000
100,000+
Additional notes about this lead
e.g. - POS systems currently in use, specific business requirements
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