Information Request – Plug'n Pay

Business Name:

Contact Name/Title:

Address:

City:

State:

Zip:

Telephone:

Best Time To Call:

Fax:

E-mail:

Your website URL:

Inquery Type:

Merchant Information Request

Reseller/Partner Information Request

Please provide us some information about your current business:

What type of business do you have?

Estimated Monthly Volume:

Job Title:

Other:

Do you currently have a Plug’n Pay account?

If you selected “Yes” above, please enter your username.

Are you referred by one of our Business Partners?

How did you hear about us?

Specific Question(s):

To better respond to your request, please indicate area(s) of interest below:

Products and Services:
WebXpress Gateway
Mobile Payments
Merchant Account
Invoice Payments
Recurring Billing
Subscriber/Membership Mgmt.
Coupon Management
ACH eCheck Services
Fraud and Risk Management

Integration and Testing:
Demo Account Login
Tokenization and API
Retail/POS Web Xpress
Open Source Carts and API
QuickBooks Integration
Multi-Currency Pricing
Dynamic Currency Conversion

Please provide us some information about your current marketing structure:

Do You Currently offer E-Commerce?:

If so, how?:

What Best Describes Your Market Position:

Est. Number of New Monthly E-Commerce Accounts:

Est. Monthly Credit Card Volumes:

Number of Salespeople:

URL of Intended Plug’n Pay Link on Your Site:

Please provide a short description of your company/product offering and how you have integrated to Plug’n Pay:

Notes or Comments: