Bank of Franklin County

Merchant Services Referral Form

Name (DBA)*
Address
Zip Code
City/Town
State
Email
Services/Products
Contact Name*
Contact Phone Number*
Best Time to Contact Merchant
Approx Monthly Credit Card Sales
Does the client currently accept credit cards?*
- Yes
- No
How does the merchant process?
Is the merchant a client of the bank?
- Yes
- No
Urgency of Request
- Normal
- Urgent
Upload Merchant Statement (optional)
Drop files here or

Accepted file types: jpg, gif, png, pdf.
Referrer Information
Name*
Email Address*
Phone Number*
Branch Name/Location*
Cost Center
Please recap your conversation with this prospect