Remedly 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.

* = Required

Referral Contact Information

First Name *

Last Name *

Title/Position

Business Name *

Email *

Phone *

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

Customer Type

Existing New

Representative Information

Referral Person First Name

Referral Person Last Name

Referral Person Email

Referral Person Phone