New Merchant Registration Form

New Merchant Registration Form

Please fill in the following section, completely and accurately. For all amendments, and/or issues, please contact us at get@simpopay.com or 1-833-900-2677
Legal Business Name*
Business HST Number*
Owner's Legal Full Name*

First NameLast Name
Owner's Phone Number*
Owner's E-mail*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Financial Information
EMT Email Address: Email
Please Upload Documents to Proceed with Application

Copy of Business Article of Incorporation or CRA LetterCopy of Owner's Driver's LicenseCopy of Void Cheque for Business Bank Account
File Upload

Copy of Business Article of Incorporation, Owner's Driver License, Bank voided Check
Cancelof
Agreement
Please review SIMPOPAY’s Agreement Below. To confirm receipt of review, Sign and Date in the indicated areas below.

I, First Name Last Namehereby represent that I have the appropriate authorization to enter this agreement on behalf of Type a label(Business Name)

I hereby grant SIMPOPAY permission to create, setup, and manage my account, and I will provide any necessary information to remain compliant.

I confirm that I have read, reviewed, and agree to SIMPOPAY’s Merchant Terms & Conditions which can be found on SIMPOPAY’s website at https://simpopay.com/merchant-terms
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Financial Information