AGENT BANKS SECTION
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• Merchant Referral Form
• Support Information
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Keep your portfolio of happy, satisfied customers growing

For your convenience we have provided you with this electronic referral form. Just fill it out and we will contact your customer within one business day. For any questions regarding your referrals, feel free to call the Sales Department at (800) 324-8323 ext. 134.
Your Name
Your Position
Your Bank
Branch Name or Number
Your Email
Your Phone
NOTE: The following information is very important and will help us to better service you and your clients.
Name of Company Being Referred
Contact
Phone
Alternate Phone
Tell us about your referral:
Type of Business
Check all that apply:
 Retail Mail Order Internet Other:
Products sold:
Current banking relationship:
 Checking Savings Loans No Relationship
VIP Account at the bank:
 Yes Description
No
Anything else you feel we should know?




UMS Banking Main Office:
750 Fairmont Avenue, Suite 201
Glendale, California 91203
Local Phone: (818) 246-6767
Customer Service/Help Desk: (800) 866-1881
Sales/Business Development: (800) 324-8323
Fax: (818) 246-0902		 Site Navigation:
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