Referral Program

Merchant First Name*

Merchant Industry Type*
Select OneFull-Service RestaurantJuice and Drink BarFine diningQuick Service RestaurantWine, Liquor and Beer

Partner E-mail*

Partner Contacts*

Please give us more information about your lead below. The more
details you provide, the more equipped we are to close the prospect:

What is the best time of day to contact the merchant?*
Select OneMorning (9am - 12pm)Mid-day (12pm - 4pm)Evening (4pm - 8pm)

Is this a new or existing business?*
Select OneNewExisting

Do they already use your services?*
Select OneYesNo

If existing, what POS System do they use?*
Select OneElectronic Cash RegisterPC Based POSTablet POSNone

When is your merchant interested in starting with Aptito?*

Notes