Partner with Confidence. Refer with ease.

When you refer to Basys, your merchants gain access to seamless and tailored payment solutions that fit their unique business needs.

Simply submit this form, and we’ll take it from there – a Basys representative will connect with your referral soon to start delivering the support they deserve.

We value your partnership and are excited to help your merchants thrive. If you have any other questions, give us a call at 800.386.0711.

"*" indicates required fields

Business Name (DBA)*

Address*

City/Town*

State*

Zip Code*

Contact Name*

Email*

Services/Products

Contact Phone Number*

Best Time to Contact Merchant*

Is the merchant a client of the bank?*

Yes

What Was the Source of this Client Referral?

Does the Merchant Currently Accept Credit Cards?*

Yes

Approx. Monthly Credit Card Sales*

How does the Merchant Process?

Upload Merchant Statement

No file chosen

Max. file size: 100 MB.

If you do not upload statements on behalf of the merchant, please ensure the merchant has these statements ready when we reach out.

Name*

Email Address*

Phone Number*

Branch Name*

Bank Officer Code*

Cost Center

Please summarize your discussion with the merchant and provide any relevant details.

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Thank you for partnering with Basys!

Partner with Confidence. Refer with ease.