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Heartland Partner
  • *Warning - It is important that a conversation with the potential partner has occurred before submitting a lead through this form. You will need your Partner's correct business information and their consent as they will receive a legal binding contract from Heartland Payments - via DocuSign. Once complete and submitted, this information will be added to SalesForce and reviewed by your Senior Director of Business Development for next steps to contract. For questions, please e-mail your respective Senior Director of Business Development.
  • Heartland Sales Information

  • Partner Information

  • Partnership Scoring

  • 12345
  • Please enter a number from 1 to 10000.
  • Partnership Details

    Choose All That Appy
  • Please e-mail [email protected] if you have any issues with the above submission form.
Partner Submit