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Home
Solutions
Equipment Solutions
Countertop Terminals
E-Commerce
Mobile Terminals
Point of Sale
Software Integration
Virtual Terminal
Products & Programs
Breach Insurance
Clover Capital
Clover Rapid Deposit
Equipment Rental
Gift Card Program
Next Day Funding
PCI Compliance
ProPay
Reporting
Surcharging
Equipment
iQ Pro
BASYS IQ
Clover Go
Clover Flex
Clover Mini
Clover Station Duo
Clover Station Solo
Desk/3500
FD150
Vital Mobile
Quick Reference Guides
Partner Programs
Association Partners
Bank Partners
Software Partners
Blog
About Us
Our Company
Our Team
Join Our Team
Contact Us
First Bank of the Lake
Name (DBA)
*
Address
Zip Code
City/Town
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Email
Services/Products
Contact Name
*
Contact Phone Number
*
Best Time to Contact Merchant
Don't Know
Mornings
Afternoons
Evenings
Weekends
Anytime
Approx Monthly Credit Card Sales
Never Accepted Credit Cards
$0-5,000
$5,000-10,000
$10,000-25,000
$25,000-50,000
+$50,000
Don't know
Does the client currently accept credit cards?
*
Yes
No
How does the merchant process?
Terminal
Software
Point of Sale System
Online Shopping Cart
N/A
Don't know
Is the merchant a client of the bank?
Yes
No
Urgency of Request
Normal
Urgent
Upload Merchant Statement (optional)
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.
Referrer Information
Name
*
Email Address
*
Phone Number
*
Branch Name/Location
*
Cost Center
Please recap your conversation with this prospect