Merchant Referral Form

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.

Full Name*
First Name Last Name
Your Position
Your Bank
Branch Name or Number
E-mail*
Phone Number*
- Area Code Phone Number
Number
NOTE: The following information is very important and will help us to better service you and your clients.
Name of Company Being Referred
Contact Name*
Contact Number*
- Area Code Phone Number
Alternate Phone
- Area Code Phone Number
Tell us about your referral:
Type of Business

Retail Mail Order Internet Other:
Products sold:
Current banking relationship:

Checking Savings Loans No Relationship
VIP Account at the bank:

Yes No
Description
Anything else you feel we should know?
Security question (to prevent spam):*
Should be Empty:

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UMS Banking is a registered ISO/MSP of HSBC Bank, National Association, Buffalo, NY. Copyright © 2010 United Merchant Services of California, Inc. All Rights Reserved. UMS, UMS BANKING, the UMS Banking logo are trademarks and service marks owned by UMS Banking.
All other trademarks are the property of their respective owners.

NOTE: The following information is very important and will help us to better service you and your clients.

Tell us about your referral: