Partner Onboarding — PayFlex Systems

Choose Your Plan

Select the tier that matches your practice volume and needs.

Starter

$499/mo

+ $250 setup

✓ Platform access
✓ Single program
✓ Up to 100 patients/month
✓ Basic reporting
✓ Email support

RECOMMENDED

Growth

$1,250/mo

+ $500 setup

✓ Multiple programs
✓ Up to 500 patients/month
✓ Card issuing
✓ Advanced reporting
✓ Priority support
✓ API access

Scale

$2,500/mo

+ $1,000 setup

✓ High-volume programs
✓ Unlimited patients
✓ White-label options
✓ Custom integrations
✓ Dedicated support
✓ SMS numbers included

Business & Practice Information

Complete KYC/KYB verification for payment processing compliance.

Business Entity Details

Practice/DBA Name *

Legal Entity Name *

Federal Tax ID (EIN) *

Business Entity Type *

Practice Type *

Group NPI Number * Type 2 NPI for organization

Year Established *

State of Incorporation *

Practice Location

Street Address *

Suite/Unit (Optional)

City *

State *

ZIP Code *

Practice Phone *

Practice Website

Authorized Representative (Owner/Officer)

Individual with authority to bind the practice legally and financially.

First Name *

Middle Initial

Last Name *

Title/Role *

Individual NPI Number * Type 1 NPI for individual

Social Security Number * Required for identity verification (encrypted)

Date of Birth *

Email Address *

Mobile Phone *

Home Address * Personal residence for identity verification

City *

State *

ZIP Code *

Ownership Percentage *

State Medical License # *

Banking & Volume Information

Bank Account Type *

Estimated Monthly Patient Volume *

Estimated Monthly Transaction Volume

Current Payment Processor (Optional)

Additional Information or Special Requirements

I agree to the PayFlex Systems Terms of Service and PayFlex.Health Program Terms. I understand that:

All fees are non-refundable
PayFlex Systems owns and controls all payment infrastructure
I cannot circumvent this platform for 24 months post-termination

Complete Payment

Enter your payment details to activate your PayFlex Systems account.

Order Summary

Growth Plan $1,250/month

Setup Fee (One-time) $500

Total Due Today $1,750

Recurring billing begins next month. You will be charged $1,250 monthly.

Billing Address

Billing address is the same as practice address

Billing address is the same as authorized representative's home address

Billing Street Address *

City *

State *

ZIP Code *

Start Your PayFlex Systems Partnership

Choose Your Plan

Business & Practice Information

Business Entity Details

Practice Location

Authorized Representative (Owner/Officer)

Banking & Volume Information

Complete Payment

Order Summary

Billing Address

Payment Method

Welcome to PayFlex Systems!