newpartner | Insight Retail Software

Partner Name *

First

Last

Partner Contact Name *

Address (No PO Box) *

Address Line 1

Address Line 2

City

State

Zip Code

Partner Phone Number *

Alternate/Mobile Phone Number

Partner Email Address *

Technical Contact Name

First

Last

Technical Contact Email Address

With whom do you currently partner with for POS systems? *

Do you resell Datacap products? *

From which supplier do you acquire your credit card terminals? *

Which company provdes your primary credit card processing services? *

How many staff members do you currently employ? *

In which states do you sell your products/services? *

Additional Comments (optional):

Payment Information *

Billing Contact Name *

First

Last

Billing Contact Email Address *

Billing Contact Phone *

Billing Address Same as Store Address *

Additional Notes

Anything we should know, preferences, etc.

New Partner Form