Account Details
Please fill in your merchant account details
Full Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Name
Best Email
*
Industry
*
Please Select
Adult chat and entertainment
Agribusiness
Alcohol, Wine and spirits.
Auction houses
Bankruptcy attorneys and counselors
Business Services
Car Dealers
CBD
Charities
Clergy & Religious Organizations
Clothing Manufacturing
Coins Dealers/Investments
Collectibles and high market value items
Collection agencies
Communications/Electronics
Computer hardware, software and repair
Conference/large event organizers
Construction
Contracts for deference (CFD)
Cosmetics / cosmeceuticals
Crowdfunding
Cryptocurrency options trading
Currency exchange
Defense
Direct marketing
Discount vouchers
Drug paraphernalia
Educational seminars
Electronic Cigarettes
Employment agencies
Energy & Natural Resources
Extended warranty companies
Financial services
Food & Beverage
Fortune tellers
Fulfillment houses
Gambling/Betting
Gun sales over the internet
Health
Hotels
Initial coin offerings (ICOs)/ initial token offerings (ITO)
Leisure Industry
Lodging / Tourism
Marketing
Marketplaces
Medical massage therapists
Medical tests and Medical devices
Misc Manufacturing & Distributing
Modelling agencies/schools
Money service bureaus
Motor vehicle parts
Multi-level marketing
Online shopping arcade
Pawn shops
Pharmaceuticals
Precious metals/stones
Real estate brokers
Recreation / Live Entertainment
Re-financing
Rendering of travel related services
Restaurants
Retail Sales
Sports, Equipment & Services
Stocks, shares, Investments
Stored value load
Textiles
Ticket agencies
Ticket brokers/agencies
Tobacco
Used car and truck dealers
Warranties
Other
Business Website
*
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Company Details
Merchant Application Form
1. FULL REGISTERED COMPANY NAME
2. COMPANY TYPE (PLEASE TICK ONE)
LTD
PLC
Sole trader
Other (Please Specify)
3. Registered Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the Registered Company Address the same as REGISTERED TRADING ADDRESS?
Yes
No
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4. REGISTERED TRADING ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
5. COMPANY REGISTRATION NUMBER
6. DATE OF INCORPORATION
-
Month
-
Day
Year
Date
7. EU VAT NUMBER
8. COMPANY PHONE NUMBER
Please enter a valid phone number.
Format: (000) 000-0000.
9. PRIMARY EMAIL ADDRESS
example@example.com
10. APPLICANT WEBSITE/S
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11. COMPANY DESCRIPTION
(PLEASE SPECIFY THE NATURE OF THE BUSINESS - PRODUCTS/SERVICES)
12. DESCRIPTOR
(NAME TO APPEAR ON CUSTOMER STATEMENTS FOR PURCHASES. THIS DESCRIPTOR SHOULD BE NO LONGER THAN 22 CHARACTERS AND IS SUBJECT TO INTERNAL APPROVAL. ANY CHANGES WILL BE COMMUNICATED TO YOU)
13. MERCHANT FULFILLMENT PERIOD
(SHIPPING AND HANDLING TIME)
14. DOES YOUR LINE OF BUSINESS REQUIRE A LICENSE?
Yes
No
15. DO YOU OFFER ANY AFFILIATES PROGRAMMES (E.G WHITE-LABELLING)
No
Yes (Please Specify)
16. DO YOU OFFER AN E-WALLET?
YES
No
17. ARE YOU SUBJECT TO ANY BANKRUPTCY OR LEGAL PROCEEDINGS?
YES
No
18. HOW MANY EMPLOYEES ARE CURRENTLY EMPLOYED?
19. IS THE BUSINESS ACTIVITY SEASONAL?
YES
No
20. TARGET MARKETS (IN %)
Rows
TARGET MARKETS (IN %)
EU/EEA
United Kingdom
United States
Rest of the World
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Company Card Sales
21. PAYMENT CARD TYPES
POS card present
Card not present - Moto
Card not present - Ecom (secure)
22.
Rows
(IN %)
ECOM 12 MONTH %
MOTO 12 MONTH %
POS 12 MONTH %
23. PREVIOUS/CURRENT NAME OF PROCESSOR AND/OR ACQUIRER
24. REASON FOR CHANGE OF PROCESSOR AND/OR ACQUIRER
25. DO YOU ACCEPT ALTERNATIVE PAYMENT METHODS
Yes (complete page 4)
No
26. DO YOU REQUIRE A POS TERMINAL
Yes (complete page 5)
No
27. DO YOU PROCESS RECURRING TRANSACTIONS
Yes
No
28. CHOSEN VALUE (FOR REPORTING VALUES ON THIS APPLICATION)
Sterling £
Euro €
29. AVERAGE TRANSACTION VALUE
30. 12 MONTH CARD EXPECTED CURRENCY VOLUME
report in currency volume, not percent.
31. CHARGEBACKS (% OF VOLUME) LAST 12 MONTHS
32. REFUND (% OF VOLUME) LAST 12 MONTHS
33. Would you like to make use of our new SFTP Reporting service?
Yes
No
34. If so, please provide an email address for SFTP Reporting communication?
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Company Bank Details
(Information below required for each Settlement Currency Bank Account)
1. ACCOUNT HOLDER NAME
2. BANK NAME
3. BANK ADDRESS
4. ACCOUNT COUNTRY
5. IBAN NUMBER
6. BIC NUMBER
7. ACCOUNT CURRENCY
8. SORT CODE (UK ONLY)
9. ROUTING NUMBER (US ONLY)
10. SETTLEMENT TYPE
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*Note: All Settlements will be Net of any fees or charges Attach a copy of the company bank statement (dated within the last 3 months), showing the account holder name. This is required for each settlement currency bank account.
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11. SETTLEMENT CURRENCY OPTION
Rows
Currency
Settlement Currency/Currencies
Transacting Currency/Currencies
Special Requirements
Directors & Shareholders Information
Rows
Full Name
Job Title
Date of Birth
Country of
Residence
Nationality
Home Address
Identification Number
Company
Ownership
%
Are you
Director or Owner?
Political
Exposed Person
(or related)
1
2
3
4
5
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Individual Information
(Required for Shareholders and Authorised Signatory)
Photocopy of Government Identification which includes (e.g. Passport or National Identification Card)
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Notice for Proof of Address: If home address is not stated on the Government Identification, proof of address is to be provided using ONE (1) of the documents below stating an individual’s name and home address. The document must also be dated within the last 3 months.
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Utility Bill (NOTE: Mobile Phone Bills are not accepted)
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Personal Bank Statement
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Equivalent Document Issued by Central or Local Government Authority, Department or Agency
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Additional Supportive Company Documents
Company Certificate of Incorporation (Upon request, must be provided as original certified true copy not older than 6 months)
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Memorandum & Article of Association (Upon request, must be provided as original certified true copy not older than 6 months)
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Good Standing Certificate or latest Annual Return. If the applicant forms part of a group, the Good Standing Certificate or Annual Return of the Ultimate Parent Company, should also be provided. (Upon request, must be provided as original certified true copy not older than 6 months)
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Last Audited Financial Statements validated by an external third party
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If the applying business is a start-up and processing history is not available, please provide a detailed business plan at least 3 years, including projected volumes, projects, financials, target market and market strategies.
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Group Company Structure Chart (if Applicant forms part of a group structure)
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Copies of Bank Statements or Void Cheque or Deposit Slip for the settlement bank account (not older than 3 months)
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Signed Trust Deed, if Applicant is a trustee of a trust.
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(Upon request, must be provided as original certified true copy not older than 6 months)
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Any applicable License (e.g Financial Institution, Payment Institution, E-Money Institution, Gaming or Investment).
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(Upon request, must be provided as original certified true copy not older than 6 months)
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A List of Affiliates / white-labels ( if applicable)
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Distribution Agreement, not older than 2 years and signed by the current Directors, if Applicant is a Digital Media or any other type of authorised reseller.
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(Upon request, must be provided as original certified true copy not older than 6 months)
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Last 6 Months Card Processing Statement from current provider
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(if there are any indications of elevated chargeback ratios, please provide an explanation as well as a chargeback remediation plan)
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Product/Service provision terms & conditions must be provided (applicable to Beta Websites)
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Lab Reports (If Required)
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Latest AML, Fraud and Chargebacks Policies and Procedures (upon request)
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Any other document that might be relevant to this application
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Heading
ADDITIONAL DOCUMENTATION TO THE ABOVE MAY BE REQUIRED DURING THE APPLICATION PROCESS AND/OR FOLLOWING APPROVAL. IF DOCUMENTATION IS NOT PROVIDED IN ENGLISH, YOU MAY BE REQUIRED TO HAVE THE DOCUMENTATION TRANSLATED, AUTHENTICATED, NOTIRISED OR OTHERWISE.IF THE ABOVE REQUESTED DOCUMENTS ARE NOT AVAILABLE IN ORIGINAL, CERTIFIED COPY OF THE ORIGINAL DOCUMENT AUTHENTICATED BY A NOTARYPUBLIC, ATTORNEY, PUBLIC ACCOUNTANT, TO BE A TRUE COPY OF ORIGINAL DOCUMENT IS REQUIRED.
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Alternative Payment Methods
Alternative Payment Methods
ALIPAY
APPLEPAY
BANCONTACT
BITPAY
CASH2CODE
EPS
GIROPAY
IDEAL
MULTIBANCO
MYBANK
PAYSAFECARD
PAYU
PRZELEWY24
QIWI
QIWI PAYOUT
REDPAGOS
SAFETYPAY
SEPA DD
SOFORT BANKING
TRUSTLY
TRUSTPAY
VERKKOPANKI (FINNISH)
VISA CHECKOUT
WECHATPAY
ZIMPLER
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Point-of-Sale Information
Terminal Physical Location
1. Terminal Location Name
2. Terminal Location House Number
3. Terminal Location Street
4. Terminal Location City
5. Terminal Location Post/ZIP Code
6. Terminal Location Country Code
7. Terminal Location Contact Name
8. Terminal Location Contact Phone
9. Terminal Location Email Address
10. Use my terminal location details for delivery
Yes
No (complete 11-19)
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Terminal Delivery Information
11. Terminal Delivery Name
12. Terminal Delivery House Number
13. Terminal Delivery Street
14. Terminal Delivery City
15. Terminal Delivery Post/ZIP Code
16. Terminal Delivery Country Code
17. Terminal Delivery Contact Name
18. Terminal Delivery Contact Phone
19. Terminal Delivery Email Address
20. Use my terminal location details for my receipt lines
Yes
No (complete 21-25)
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Receipt Delivery Information
21. Receipt Line 1
22. Receipt Line 2
23. Receipt Line 3
24. Receipt Line 4
25. Receipt Line 5
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26. Number of PIN pad terminals to be delivered to this address
27. Number of Counter top terminals to be delivered to this address
28. Number of Mobile terminals to be delivered to this address
29. Number of mPOS terminals to be delivered to this address
30. If you have ordered Mobile terminals, how many simcards do you require to be delivered to this address?
(Note: You only require this if your terminal will be used “on the go” without a wi-fi or cable connection)
31. If you have ordered Mobile terminals, how many sparecharging cradles do you require to be delivered to thisaddress?
(Note: your terminal comes with charging cables as standard, this is for additional cradles and represents an additional cost)
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PCI DSS Compliance
PCI DSS Certification Level
The Payment Card Industry Data Security Standard (PCI DSS) is a compliance requirement for merchants to enable safe payment trans-actions and ensure cardholder data is stored securely. Merchants that store cardholder data must be PCI DSS compliant or assume full liability for (i) cardholder losses caused by data theft, and (ii) any fines imposed by card schemes. More information can be found onhttps://www.pcisecuritystandards.org/pci_security/
PCI DSS is based on the total number of yearly credit card transactions processed. (Total Yearly Credit Card Transactions)
Rows
Over 6 Million
1-6 Million
20,000 – 1 Million
Under 20,000
PCI Level 1
PCI Level 2
PCI Level 3
PCI Level 4
Type a question
Check if you are already PCI DSS compliant.
Check if you would like to make use of STFS Portal for completing your PCI Self-Assessment Questionnaire. (Please note, fees apply to this service and will be agreed as part of your contract).
If you are already PCI DSS compliant. A copy of your PCI DSS Certification, Self-Assessment Questionnaire and latest ASV scan must be provided.
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Full Name
Date
-
Month
-
Day
Year
Date
Signature
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Thank You
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