First Bank of the Lake - BASYS Processing

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?*

How does the merchant process?

Is the merchant a client of the bank?

Urgency of Request

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Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Referrer Information

Name*

Email Address*

Phone Number*

Branch Name/Location*

Cost Center

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