Partner Referral

Partner with us to grow your business locally, regionally or globally.

Please contact our sales team to receive the correct link

Partner Referral Details

Please fill out the following form to provide referral information to Verifone.

Referring Partner Name

First Name *

Last Name *

Referring Partner Email Address

[email protected] *

Referring Partner Job Title

Job Title of Referring Partner *

Referring Partner Company Name

Referring Company Name *

Merchant Company information

Merchant Trading Name

Merchant Trading Name *

Merchant Legal Name

Merchant Legal Name *

Merchant Industry

Merchant Industry *

Merchant Trading Address

Street Address *

Empty

Street Address Line 2 *

Empty

City *

State / Province *

Merchant Trading Postcode

Merchant Trading Postcode *

Merchant Contact Information

Merchant Contact Name

First Name *

Last Name *

Merchant Job Title

Merchant Job Title *

Merchant Email Address

Merchant Email Address *

Merchant Contact Number

Merchant Preferred Contact Time

Merchant Payment Information

What is the Merchant Interested in? *

In-store

Ecommerce/CNP

Both/Omnichannel

Current Number of Terminals/PEDs

Current Number of Terminals/PEDs *

Current Ecommerce Supplier

Current ePOS Supplier

Current ePOS Supplier *

Current Acquirer

Current Acquirer *

Volume of Transactions per Annum (Ecomm/CNP only)

value_of_transactions_per_annum

Value of Card Transactions per Annum

Value of Card Transactions per Annum *

Number of Terminals/PEDS Required

Number of Terminals/PEDS Required *

Any Additional Details of Referral

Consent to Data Use

I understand that this data will be used for partnership purposes *

I give permission for Verifone to contact the merchant directly