CARD PROCESSING APPLICATION FORM

Website Information

URLs*

Login Details (If Any)

User ID (If Any)

MID Descriptors

Max 25 Characters

Business Information

Description of the Product / Service*

Marketing Strategy

Business Experience in this Sphere (Years)

Length of Time Accepting Payment Cards (Years)

Number of Employees

MCC Code

YesNo

If Yes, What Type of Licence

Monthly Sales Volume (Last 6 Months)

Monthly Number of Transactions (Last 6 Months)

Monthly Chargebacks Volume (Last 6 Months)

Number of Chargebacks (Last 6 Months)

Lowest / Average / Highest Ticket (i.e. Transaction Amount)

Types of Cards (Please Specify)

ESTIMATED MONTHLY TURNOVER for New Processor

Sales Volume

Number of Transactions

Max Number of Transactions per Card Daily / Weekly / Monthly

Lowest / Average / Highest Ticket (i.e. Transaction Amount)

Types of Cards

VISA % / Mastercard %

Processing Currencies

Settlement Currencies

Payment Model (One Time Payment / Recurring / Pay per Minute)

Transaction Types (Online Payments / MOTO / 3D secure)

Main Regions of Transactions for EU % - US & Canada %

Other % (Name Countries)

Current Gateway / Acquirer

Reason for Leaving Current Acquirer

Company Details

Company Name

Country of Registration

Company Registration Number, Tax Identification Number

Legal Address (Physical Office Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone/Skype

E-mail

Director Information

Name*

First NameLast Name

Date of birth

Date

Passport/ID No

Issuing Country

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Ownership Profile

INFORMATION ON BENEFICIAL OWNER No.1

Name

First NameLast Name

Date of birth

Date

Email Address

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Country CodePhone Number

Skype / Telegram

YesNo

Passport / ID No

Issuing Country

INFORMATION ON BENEFICIAL OWNER No.2

Name

First NameLast Name

Date of birth

Date

Email Address

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Country CodePhone Number

Skype / Telegram

YesNo

Passport / ID No

Issuing Country

Account Owner

Bank Name

Bank Address

Currency, IBAN Number

KYC DOCUMENTS: Corporate Documents

Certificate of Incorporation issued by the Company Registrar
Memorandum and Articles of Association
Certificates listing the current directors, current shareholders and registered address of the Customer issued by the Company Registrar (document must be less than 6 months old)
Letter of Good Standing - needs to be renewed every 5 years.
Incumbency certificate - Maximum 6 months old
Board resolution confirming appointment of Authorized Signatory (if applicable) - Power of Attorney
Office rental agreement

Authorized Signatories, Directors:

Passport and second ID document (i.e. driving license)
Utility bill, personal bank statement or credit card statement (less than 3 months old) with clearly stated residential address
Documents confirming authorized signatory person's relevant level of experience (CV, professional certificates, etc)
Passport, ID card only for European citizens
Utility bill, personal bank statement or credit card statement (less than 3 months old) with clearly stated residential address
CV (with detailed work experience)
Documents confirming beneficial owner's good financial condition (Bank Reference Letter or Bank Statement signed and stamped by the bank representative or copy of credit card statement and masked copy of credit card issued on the name of the UBO

Please note that by filling in and submitting this form, any related documents and information, you agree that LATPAY.CO can process, store and share this form, documents and information with payment partners for coordinating service offering for your business.

KYC Company Docs

Upload Documents

Passport / ID Card / Utility Bills

Upload Documents

BY SIGNING BELOW I AGREE THAT:

All details that I have given in the Application form are true and correct, and I shall update LATPAY.CO immediately if there is any change.

I have the authorization to sign the Application Form on behalf of the Company and I am not acting as an agent, nominee, or trustee for third parties.
No directors or shareholders have ever been: convicted of any offense (other than minor offenses); adjudged bankrupt; subject to an investigation by a governmental, professional, or other regulatory body; an officer or shareholder of a business entity which has been the subject of an investigation as aforesaid, or which has been adjudged bankrupt, compulsorily wound up or has made any compromise or arrangement with its creditors.

The company has not been, is not, and will not be involved in, and that its wealth and funds do not derive from, any illegal or criminal activity, including but not limited to money laundering, funding of terrorism, and/or tax evasion.

The company will comply with all applicable laws, including but not limited to Payment Services Directive 2, anti-money laundering and terrorist financing laws, rules and regulations throughout our business relationship

LATPAY.CO or LATPAY.CO partners may process my personal data to provide the agreed services and to comply with privacy, card scheme, anti-money laundering, and all other applicable laws.

I also agree that, where applicable, LATPAY.CO also provides or makes such data available to card schemes, acquirers, banks, payment gateway services, and/or other third parties to perform the agreed services.

Where applicable, LATPAY.CO may provide my data to referrers that have to introduce me to LATPAY.CO only for the calculation of the fees due by LATPAY.CO to said referreral and in accordance with the data minimization principle set out by GDPR.

The personal data will be stored in a secure environment for a period of 5 years in order to comply with all applicable laws. At the expiry of such a period, personal data will be destroyed.

The consent is provided for an unlimited period until it is revoked. I may exercise all the rights granted to LATPAY.CO by the General Data Protection Regulation (EU) 2016/679 and in particular the right of rectification, erasure, and objection by sending an e-mail to info@latpay.co. In such a case, the provided personal data will be updated, blocked, or deleted unless otherwise required by the applicable laws.

Receiving electronic mail or advertising messages may be revoked in the same manner at any time.

I agree LATPAY.CO may provide us with newsletters and marketing material regarding its services by email, sms, mail or telephone.

Please Sign

CARD PROCESSING

BUSINESS PROFILE

TRANSACTION INFORMATION

SETTLEMENT BANK ACCOUNT INFORMATION