GPI Rep Name * :


Business Name * :


Contact's First Name * :


Contact's Last Name (Surname) * :


Contact Number * :


Email Adress * :


What is the reason for sending to FPP? * :
Turnaway: Prohibited Business Type
Underwriting Could Not Approve
Account Closed by Risk

Reason Underwriting Terminated this MID (only applies to Risk closures) :


Reason Underwriting Could Not Approve (only if application was submitted) :


Is this a live transfer? * :
Yes - I successfully sent FPP the call
Yes, I tried calling FPP, but they were busy
No, I never attempted to transfer the call

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If this is not a live transfer, please fill in the fields below
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Alternate Number :


Website URL (if available) :


Business Type and/or Description * :


Average Ticket :


Average Monthly Volume :


What equipment solution and pricing did you discuss, e.g. terminal, POS, gateway, etc.? :


Did you send the merchant an email with supporting docs attached? * :
**please email the merchant any important documents that you've gathered during the sales process, e.g. processing statements, application, bank statements, articles of org., etc. Please instruct the merchant that we will be asking them to forward us that email after we have established initial contact. This will greatly help us reduce the amount of time it takes to get these merchants approved, which will also increase your chances of getting pad!
Yes, I've sent the merchant the documents in an email titled "Forward to Fort Point Payments"
No, I never gathered any documents since they're an unqualified business type

Notes :


Please Confirm Verbal Consent * :
**by clicking this box you confirm that the merchant verbally agreed on a recorded line to have Cayan pass the info on this form to Fort Point Payments, Inc., in order to arrange merchant services that Cayan was unwilling or unable to provide
Yes
No, I was given special permission to bypass this requirement

When did the Merchant Give Verbal Consent? * :
I still have the merchant live on the line
Within the last 15 minutes
Within the last 1 hour
Earlier today
Within the past week