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Welcome, Coulee Bank Valued Member

Evolve Payment is Coulee Bank’s trusted community partner for merchant services. Evolve Payment acts as a partner advocate for Coulee Bank’s valued merchants and is excited to welcome you into the Evolve Payment family to help you Bank with Confidence.

Before we kickstart our new relationship, we want to better understand your merchant needs and how we can best serve you. Please complete the following form in as much detail as possible. If applicable, we also request the past three months of current statements for your merchant account.

After you submit the form and we look over your information, a member of our team will reach out to you to schedule an introductory meeting. If you have any questions, don’t hesitate to give us a call, send us an email, or submit our contact form. We look forward to hearing from you!

Coulee Bank Referral Form

    Merchant Contact Information

    Payment/Business Information

    Credit Card(s) Accepted

    Current Bank Customer?

    Business Type?

    Method of Acceptance

    PCI Compliant?

    Payment Equipment

    Additional Information

    Upload 3 Months of Current Statements (Optional)

    Banker Information

    If you are a banker completing on behalf of a client, please provide your information below. Otherwise, please leave this section blank.