Shakti Lead - Card Pay from the AA

Business Trading Name*

Contact First Name*

Contact Last Name*

Address*

City*

County*

Postal Code

Email*

Phone*

Shakti Rep Name*

Shakti Rep Email*

New to Cards or Switcher?

New to cards
Switcher

Current Provider

Elavon
Worldpay
Barclaycard

Expected Monthly Turnover*

Supporting Information*

Upload Statements

I have read the following statement to the customer and the customer has agreed as follows:*

“Do you consent to Shakti Buying Group giving your contact details (that is your name, contact address and phone number) to EVO Payments International GmbH Branch UK(trading as ‘Card Pay from the AA”) so that they may use your details to contact you in relation to their products and services. Please note that Card Pay from the AA is a separate legal entity from the AA and its subsidiaries’’

Please tick box if consent given

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Card Pay from the AA

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