JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
CMS Partner Referral Form
For Partners of Collins Merchant Services please fill out this form to receive credit for your referral.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Referring Partner: First and Last Name
*
Your answer
Referring Partner Business Name
*
Your answer
Name of Business you are referring
*
Your answer
Contact Name (first and last)
Your answer
Merchant Industry (i.e. Retail)
*
Your answer
Merchant Phone Number
*
Your answer
Merchant email address
*
Your answer
What service is this business interested in?
Cost Savings Analysis (CSA)
Biller Genie Demo
Quick Fee _ Buy Now Pay Later (BNPL)
Fundomate Capital Loan
ADP Payroll
Other
Clear selection
To do a CSA - Did you obtain a Merchant Statement from their credit card processor? (PayPal, Square, Stripe, QBO, Xero, Accounting Suite, etc.)
Yes
No
Other:
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Collins Bookkeeping Solutions, LLC.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
