gsb.powerpay.bizGorham Savings Bank - PowerPay

PowerPay / Referral Form Thank you for referring your customer or prospect to PowerPay. Referrer Information Name: Branch or store: Position: Phone: ? Email: Business you are Referring Business name: Business phone: ? Business address: Business city: Business state: Alabama Alaska Alberta Arkansas Arizona British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nevada Nebraska New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Contact name: (Required) Contact title: Contact phone: ? (Telephone or email is required) Contact email: (Telephone or email is required) Is the prospect currently processing? Yes No Does the prospect currently do business with you? Yes No Would you like us to contact you to discuss the referral prior to contacting them? Yes No What is their interest in PowerPay? characters remaining Are there details we should know prior to making contact? characters...