Capital Bankcard Agent Name :

Capital Bankcard Agent Email (we can CC you on all email communications with your referrals) :

Agent ID # :

Agent Contact Number :

_______________________________________________________________________

Merchant's Business Name * :


Merchant's Name * :


Merchant's Phone Number * :


Merchant's Email Adress * :


Business Website URL (if available) :


What is the reason for sending this lead to HTP? :
Was declined by underwriting
App was never submitted due to being a prohibited business type

Is the merchant aware that they will be receiving a call from Fort Point Payments? :
Yes, I have spoken to the merchant, and they are waiting for the call
Sort of, I left a message and/or sent an email informing them that FPP would be calling them
No, I have not notified the merchant that FPP will be contacting them

Notes :