Card Terminal Order Form

First Name *

Email *

Phone Number- Preferably Mobile

Lead Source *

This is a referral by a customer

Please select your total annual switcher CTO *

Below £150,000 or all locations new to card
Fixed Pricing
Switcher statement not required

£150,000 and above
Bespoke pricing
Switcher statement required

Creadit Cards % *

Debit Cards % *

Debit Fee £ Per Transaction *

Visa Business Debit Cards % *

Other Business Cards % *

Last Name *

The customer wants to hear about new products and service from Paymentsense.

Business Name *

Add Business Address *

Add Business Address

Location nickname *

Do you currently take card payments? *

Yes

What is your estimated card turnover per month? *

What is your estimated average transaction value? *

Agreement Length *

Please Click Add New Button to Enter Details

PCI Management *

Would you like the ability to process Amex payments? *

Yes

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