Become a Partner

Establish a Partnership with Chase Paymentech - a leader in payment processing solutions. Please complete the form below so we can review your request. Any ideas, proposals, or other information (collectively, "Information") submitted or collected on this form shall be considered non-confidential and non-binding.

Answers to all questions are required except those marked as optional.
In addition, please leave a space between postal code e.g. L6K 3J4.

Please tell us who you are.

Company Name:
Contact First Name:
Contact Last Name:
Title:
Address:
City:
Province/State:
Postal/Zip Code:
Telephone Number:
Email Address:
Web Address:

If Other, URL of page containing link to Chase Paymentech (Optional):

Description of Business(description of products/services sold):

Please give a brief description of your proposed partnership with Chase Paymentech, including how this partnership would benefit Chase Paymentech and/or its merchant base: