Language
English (US)
Merchant Application Form
This form has 5 sections and will take about 30 minutes to complete.
Section 1: Applicant Details
Please fill in the requisite details of your company.
Legal Company Name
*
Trading Name
Trading Name
Type Of Business
*
Company Registration Number
*
Registered Address
*
Year Of Incorporation
*
-
Day
-
Month
Year
Current Monthly Sales Volume (USD)
Expected Monthly Sales Volume (USD)
Lowest Ticket Size (USD)
Highest Ticket Size (USD)
Average Ticket Size (USD)
Expected Monthly Transaction Count
% Of Orders Processed By Telephone
Website URL(s)
Please Tick If Applicable To Your Website(s):
*
Billing Descriptor Part 1
Billing Descriptor Part 2
1.1 Contact Details
Please provide the relevant contact information.
Technical / Integration Contact
Name
Email
Phone Number
-
Business Contact
Name
Email
Phone Number
-
Risk / Chargeback Contact
Name
Email
Phone Number
-
Support / Email Notification Contact
Name
Email
Phone Number
-
1.2 Merchant Bank Account Information
Please provide account details in which you will be settled
Bank Name
Bank Address
SWIFT BIC
Account Number
IBAN
Account Currency
Beneficiary Bank Rounting Number
Local / Domestic Bank Code
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Section 2: Beneficial Owners
Please ensure that all owners with 25% or more of direct or indirect ownership in the applying Company are listed.
Number(s) Of Beneficial Owner(s)
*
1
2
3
4
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Beneficial Owner 1
Name
Ownership
Direct ownership
Indirect ownership
% Of Ownership
ID Document Number
ID Document Type
Phone Number
-
Email
Current Home Address
Nationality
Company Registration Number
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Beneficial Owner 2
Name
Ownership
Direct ownership
Indirect ownership
% Of Ownership
ID Document Number
ID Document Type
Phone Number
-
Email
Current Home Address
Nationality
Company Registration Number
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Beneficial Owner 3
Name
Ownership
Direct ownership
Indirect ownership
% Of Ownership
ID Document Number
ID Document Type
Phone Number
-
Email
Current Home Address
Nationality
Company Registration Number
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Beneficial Owner 4
Name
Ownership
Direct ownership
Indirect ownership
% Of Ownership
ID Document Number
ID Document Type
Phone Number
-
Email
Current Home Address
Nationality
Company Registration Number
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2.1 Director / Authorised Signatory
Is The Beneficial Owner A Director/Authorised Signatory?
*
Yes
No
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2.2 Director Details
Name
ID Document Number
ID Document Type
Email
Phone Number
-
Current Home Address
Nationality
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Section 3: Additional Information
Please provide further information about your company.
Does Your Company Fulfill Orders Directly?
Yes
No
Not Applicable
If 'No', Please Provide Fulfillment Details
Does Your Company Operate Affiliate Programs?
Yes
No
If 'Yes', Please Provide Details Of Your Affiliate Programme
Name Of Previous/Current Processor(s) And/Or Acquirers(s)
Reason For Applying To Open Acquiring
Email
Is Your Website PCI DSS Compliant Or Are You Using The Services Of A PCI Compliant Host?
Website is PCI DSS compliant.
Using a PCI compliant host.
Is not PCI
Is it a regulated business
Yes
No
if yes, name of regulator
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Name and address of external auditors
Section 4: Official Documents
Max file size: 10.6mb. Accepted files are PDF, JPEG, PNG, XLS XLSX, CSV, DOC, DOCX and ZIP.
Valid certificate of Incorporation or commercial registration
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By-Laws/ partnership agreements/ Memorandum & Articles of Association
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Any governmental licenses, permits, approvals and authorizations necessary to conduct business (including any export licenses).
Upload File(s)
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Latest audited annual Report or financial statement
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PCI certification
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Location of data centre with some supporting document
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Intellectual Property Rights:
(a) Registration documents or certificates evidencing the patent, copyrights, trademarks in the Software.
Upload File(s)
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(b) Software architecture and hardware architectures (if applicable) / Network diagram
Upload File(s)
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Section 5: Terms And Conditions
Please read the below T&Cs.
Terms And Conditions
*
Signature
*
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