Use this form if you are interested in registering as an Agent of Bluefin. This is a pre-qualification application, you will be contacted by a Bluefin representative in order to complete the registration process.
* First Name
* Last Name
Company Name
Contact Title
*Street Address
Suite #
*City
*State
*Country
*Contact Phone
*Contact Email Address
Web Site Address
*Number of transactions per month
Select One 10,000 or less 10,000 - 50,000 50,000 - 100,000 100,000 - 500,000 500,000 - 1,000,000 Over 1,000,000
*How many merchants do you setup per month?
How would you categorize your typical customer profile?
[click more than one if applicable] Small Businesses (< 10,000 Transactions) Mid-Tier Companies (< 100,000 Transactions) Large Organizations (Over 100,000 Transactions)
What providers do you currently use to process your transactions?
How many active customers / users do you currently have?
---Select One --- Less Than 100 Between 100 - 1,000 Between 1,000 - 10,000 Between 10,000 - 25,000 Between 25,000 - 100,000 Between 100,000 - 250,000 Over 250,000
Additional Comments or Questions:
