SmartGate Ecom
Application Form
What is your companies legal name?
*
Primary contact
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
*
example@example.com
Skype
Company Incorporation Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your incorporation address the same as your trading address?
*
Yes
No
Trading address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of referrer/ partner, if applicable
URL's
*
Industry sector
*
Please provide a brief description of your business model:
Requirements
*
MOTO
ECOM
POS terminals
Current Processors/ Acquirers
Current Monthly Processing
*
Projected processing with SmartGate
*
Minimum Transaction Value
Average Transaction Value
Maximum Transaction Value
Target jurisdictions/ Geos
*
European Union
LATAM
ASIA
USA
Rest of the World
Certificate of incorporation
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Proof of physical office (Lease agreement, Utility bill)
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of
Proof of licence or Legal Opinion Letter (s)
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of
Shareholder Certificate
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of
Business Plan and Cashflow Forecast
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of
Bank Settlement Account verification or Letter of Good Standing
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of
Proof of Domain Ownership
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of
Processing Statements (Most recent 3-6 months processing history including chargeback and refund info)
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of
File Upload
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of
Director 1
*
First Name
Last Name
Director 1 email
*
Director 2
Director 2 email
Ultimate Beneficiary Owners
Over 25% shares in the company
UBO 1
*
First Name
Last Name
UBO 1 share %
*
UBO 2
First Name
Last Name
UBO 2 share %
Valid passport copy of all appointed Director(s) & UBO(s)
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of
Recent Utility Bill of all appointed Director(s) & UBO(s)
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of
Submit
Should be Empty: