Retail Solutions to BOIPA Lead - BOI Payment Acceptance

Business Trading Name*
Contact First Name*
Contact Last Name*
Address (Incl postcode)
Email*
Phone*
Retail Solutions Rep Name*
Retail Solutions Rep Email*
New to Cards or Switcher?
- New to Cards
- Switcher
Current Provider
- Elavon
- Worldpay
- Barclaycard
Supporting Information
I have read the following statement to the customer and the customer has agreed as follows:*
“Do you consent to the Retail Solutions giving your contact details to BOI Payment Acceptance so that they may use your details to contact you?’’
- Please tick box if consent given