Enterprise Bank

Referrer First & Last Name*

Referrer Email Address:*

Submitter First & Last Name:

Submitter Email Address:

Merchant's Business Name(DBA):*

Merchant First Name:

Merchant Last Name:

Merchant Business Address:

Merchant City:

Merchant State:

Merchant Zip:

Merchant Email Address:*

Merchant Phone:*

Phone Type:*

I agree to receive text messages from Fitech

Best Time to Call Merchant:

Merchant's Current Payment Provider:

Merchant's Preferred Language

Have merchant statements to upload?*

Yes No

Does merchant know Fitech will be calling?*

Yes No

Does merchant have an active account with you?*

Yes No

Branch or Location*

Special Comments from Referrer

Upload up to 5 statements, as pdf, word, jpeg or png files. Maximum file size 4MB. If you need to send a larger file, please email the file directly to sales@fitech.com

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