Order Number Your First Name * Your Last Name * Your Email Address * What is the name of your organization? * Event Information Event Date * How many guests are your anticipating attending your event? * Credit card volume at last year's event * Please let us know your estimated credit card volume. If you are not sure, an estimate is OK. Reactivation fee $125 - We will be using Spire's hardware $75 - we will be using our own hardware Will you require additional Spire units (hardware)? If so, how many? 0 1 2 3 4 5 6` Spire Payment Solutions provides our clients with the ability to sell tickets and other items online. Would you be interested in learning more? Yes No Contact Name Please provide us with a contact person and shipping address if it is different than you organizations main address. First Name Last Name Contact Cell Phone Contact Phone * Contact Email address * Is the the address where you would like the Sync 3 notification sent to ? * Yes No If not, please provide us with the email address you would like all notifications to be sent to Is the shipping address different than your organizations main address? * Yes No Shipping Address Street Address City State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Does this location accept deliveries during normal business hours? Yes No If special hours are needed for delivery, please explain what is required. Please tell us about your banking relationship. Who is your deposing bank, and what are the last 4 digits of the depositing account? What is the name of your bank? * What is the last 4 digits of the deposit account number? * Does this bank account have an ACH block attached to it? If * YES, We have an ACH block in place NO, We do not have a block on our bank account If you have had a change in bank accounts since your last event, please void a new check, scan it and send it to us. If you do not have your permanent checks, please have your new bank issue you a bank letter on their letter head confirming your routing number and account number. Upload PDF or copy of your voided check / bank letter REACTIVATION AUTHORIZATION I accept the above as a quote for service and understand that should the total approved charges for the actual event fall either above or below the anticipated credit card sales, the fees will be adjusted according to Spire Payment Solutions designated fee structure. Authorizing parties name First Name * Last Name * Authorizing parties title * Authorizing parties phone * Authorizing parties Email * Date of acceptance * We are honored to have you choose Spire as your event payment processor! Thank you for your continued business and support! Captcha *
