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1
Contact Information
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First and Last name
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2
Agent Company Name
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3
Company information
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Company registration number
Company WWW (please enter all, if there is more than one)
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4
Company address details
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Company name
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ZIP code
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United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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5
Please enter contact to person legally authorized to represent the entity
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Please enter Name and Surname
Position
Please enter email
Please enter phone number
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6
Please describe your services
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Please enter all the areas of activity in which you operate, e.g. cryptocurrencies, sale of clothes, transport services. Who is your target group, are you cooperating with final client or with agents, describe the process of purchase.
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7
Please choose what service/services you apply:
*
This field is required.
Please chose only one of the checkboxes:
e-commerce / acquiring
payout / cash disbursement - you want to send cash globally
card to card service - you want to provide Person to Person (P2P) transfers
ASP - Ancillary Service Provider - you want to provide a technical solutions for Merchants
3D Secure and Processing
ASP - Partner - you would like to provide Merchants to Fenige (no technical solution from your side)
ecommerce and payout
e-commerce and card-card
card-card and payout
e-commerce, payout and card-card
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8
Transaction information (e-commerce):
Needs to filled when You apply for e-commerce service. If no, please leave these fields empty
What is your expected monthly volume in EUR?
What is your expected average value of a single transaction in EUR
Please indicate countries of transactions. If there is more than one please enter all of them.(for e-commerce - countries of transactions authorisation)
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9
Transaction information (payout):
Needs to filled when You apply for payout service. If no, please leave these fields empty
What is your expected monthly volume in EUR?
What is your expected average value of a single transaction in EUR
Please indicate countries of transactions. If there is more than one please enter all of them.(countries you would send money to)
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10
Transaction information (card-card):
Needs to filled when You apply for card-card (P2P) service. If no, please leave these fields empty
What is your expected monthly volume in EUR?
What is your expected average value of a single transaction in EUR
Please indicate countries of transactions (sender and receiver card country)
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11
How many % of transactions will be send from European Union?
Please fill this field if you apply for e-commerce or card-card service. E.g. - 70% of your customers are from EU and 30% outside EU Zone. Please choose from the list below:
more than 90% customers are from EU
71-90% of customers are from EU
51-70% of customers are from EU
31-50% of customers are from EU
11-30% of customers are from EU
less than 10 % of customers are from EU
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12
How many % of transactions will be send to European Union?
Please fill this field if you apply for payout or card-card service. E.g. - 70% of your customers are from EU and 30% outside EU Zone. Please choose from the list below:
more than 90% customers are from EU
71-90% of customers are from EU
51-70% of customers are from EU
31-50% of customers are from EU
11-30% of customers are from EU
less than 10 % of customers are from EU
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13
Did you have any acquirer before?
*
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Important information considering AML/Risk evaluation
YES
NO
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14
Please verify that you are human
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15
How many Merchants you will provide to Fenige within first 6 months:
0-3
4-7
7-10
more than 10
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Should be Empty:
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