Email *

Company *

First Name *

Last Name *

What is your role in the industry? * Gateway PSP Other

How many of your merchants want to connect to Spreedly? * 0 1-3 3-5 5+

Do you have the engineering resources to contribute to Active Merchant? To connect to Spreedly, you would need to submit an integration to ActiveMerchant, an open source Ruby library. * Yes No

What are the major regions you participate in? Please select all that apply. * North AmericaLatin AmericaEuropeMiddle EastAsia PacificAfrica

What industry do you participate in? Please select all that apply. * Online Entertainment & GamingRestaurants & Delivery ServicesTravel & HospitalityTransportationRetailFinancial ServicesOther

Will you allow Spreedly to submit a direct PAN? * Yes No

What else should we know about your company and integration request? *

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