MERCHANT SERVICES APPLICATION

Please note that all fields must be filled out to approve your application
CORPORATE INFORMATION
Company DBA (Doing Business As) / Trading Name:
Company Name: Business Registration Number:
Country of Incorporation: Date business established (MM/YY):
Business Mailing Address
Street: City:
State: Country:
ZIP Code:  
Type of Business
Sole proprietorship: Partnership: Corporation: Other:
WEBSITE
Website URL:
Industry:
PERSON OF CONTACT
Name:
E-Mail address:
Position:
BUSINESS INFORMATION
Estimated commitment of total Volume per month USD:
Estimated total number of transactions per month:
Average transaction size USD: Highest transaction size USD:
Do you require MOTO? (Virtual Terminal, i.e. phone orders): YesNo
Required Payment Method and Currency:
Preferred settlement currency:
RMB     EUR     USD     HKD     MYR     VND     THB
INTEGRATION
Do you need assistance with the API Integration from our IT department? YesNo
Are you offering memberships on your website? YesNo
REFERRED BY:
Specify :