Full Name (*)

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Company:

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POS System:

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Phone (*)

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E-mail (*)

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Preferred Method of Contact:

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What industry does your system target?

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What platform(s) is your system compatible with? (check all that apply)

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How many active installations do you have?

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What is your current PA DSS Validation Status?

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Who sells your system?

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Why are you interested in Paygistix? (check all that apply)

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Do you currently have a gateway integration(s)?

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If yes, what gateways do you integrate with?

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Comments / Questions

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