Congratulations on taking the first step in partnering with the leader in value added solutions!
Partnering with Paya process:
  • Complete form below and submit
  • Relationship Manager will contact you within 48 hours
  • Agreement and buy rate pricing will be forwarded to you.
Contact Information (* Denotes Required Field)
First Name:*   Last Name:*
Phone:*   E-mail:*
      Verify E-mail:*
Job Title:   Company:
Street:   Street 2:
City:   State:
Zip Code:      
Current Processing Information (Optional Information)
Credit Card Processor(s):   # Check Apps Activated Monthly:
Check Processor:   # Card Apps Activated Monthly:
Gift Card Processor:   # Gift Apps Activated Monthly:
      # of Sales Agents:
      # of Sales Offices:
National Presence?:   Regional Presence?:
Primary POS Terminals:
Other Virtual Terminals / Gateways:
Information About Your Company Needs (Optional Information)
  Inquiring about:
How did you hear of Paya?:
Additional Comments / Questions
Additional Comments / Questions:
[email protected] 877-454-3835 (Sales Support Dept.)