top of page
Home
Verity Wix Submissions
Agent Info
Agent Name
Agent Email
Account Info
DBA
MID (if applicable)
Wix order type
Merchant Point of Contact (POC) Info
Merchant POC Name
Merchant POC Email
Merchant POC Phone Number
Additional Noes:
Upload File
Upload PDF only
Submit
Thank you! We will reach out to your merchant shortly!
bottom of page