Sign Up Now

Sign Up

>

$0 COST TO YOUR COMPANY | No Monthly Fees. No Set Up Fee. No Account Fees.

Input 1 payments

1
Welcome
2
General Info
3
Credit Info

Welcome to Input 1 Payments Sign Up!

Let's get you set up so you can start taking safe and secure digital insurance payments at NO COST to your company.

Name: *
Company: *
Phone Number: *
Email: *

General Information

Tell us about your business.

Legal Business Name:
Business Address:
City:
State: *
Zipcode:
Business Phone:
Client Contact Phone:
Client Contact Email:
Business Website URL:
Federal Tax Number:

Credit Info

Tell us about your expected transactions.

Do you currently accept Visa/MasterCard?:

Yes No
What payment platform are you currently using if any?:
What is your expected average monthly credit card payments:
What is your expected average monthly ACH payments:
What is your expected average payment amount?:
What is your expected annual premium amount?:

Get in Touch:

sales@input1.com | (888) 882-2554 x2135