Mitchell1 Sales Referral Form

Sales Representatives – Please use this form to enable Global Payments Integrated to track and report on the status of your merchant lead referral. A representative will contact your referral shortly.

Referral Contact Information

First Name ^*

Last Name ^*

Mitchell1 Account # ^*

Title/Position

Business Name ^*

DBA street address^*

DBA City ^*

DBA State ^*

DBA Zip Code ^*

Email ^*

Phone ^* Format: 123-456-7890

Tell us any information relevant to this customer that would be helpful for our merchant sales team.

Customer Type

Existing

New

Representative Information

Rep First Name ^*

Rep Last Name ^*

Sales Rep ID # ^*

Rep Email ^*

Rep Phone ^* Format: 123-456-7890