Reliant Agent Name :

Reliant Agent Office Name :

Reliant Agent Email (we can CC you on all email communications with your referrals) :

Reliant Agent Contact Number :


Business Name * :

Contact Name * :

Contact Number * :

Email Adress * :

Business Website URL :

Business Type and/or Description * :

Average Ticket :

Average Monthly Volume :

What is the reason for sending this lead to HTP? :
Was declined by underwriting
App was never submitted due to being a prohibited business type

How would you like us to work this lead? :
Work directly with the merchant to efficiently close the deal
Please call me, before reaching out to the merchant, for a brief discussion
Merchant insists that I work with them throughout this process. Please communicate exclusively through me

Is the merchant aware that they will be receiving a call from Fort Point Payments? :
Yes, I have spoken to the merchant, and they are waiting for the call
Sort of, I left a message and/or sent an email informing them that FPP would be calling them
No, I have not notified the merchant that FPP will be contacting them

Notes :