Website Form

1
What is your full name?* This field is required.
First Name
Last Name
2
What is your email address?* This field is required.
example@example.com
3
What is your phone number?* This field is required.
4
What is your company's name?* This field is required.Please provide the full company name!
e.g. My Company Limited
5
What is your title?* This field is required.
e.g. CEO, VP Sale, etc.
6
What is your company's website address?* This field is required.
7
In which country do you live?* This field is required.
8
In which country is your company incorporated?* This field is required.
9
Please select whether you operate as an individual (sole trader) or as a registered company* This field is required.
Sole Trader
Registered Company
10
What industry are you in?* This field is required.Please choose the answer that best describes your business!
Please Select
Please Select
Accommodation Services Provider
Accounting Services Provider
Adoption Agency
Adult Content Services Provider
Adult Physical Goods Seller
Advertising Services Provider
Airline
Alcohol Seller
Amusement/Recreation Services Provider
Animal/Animal Parts Seller
Appliance Cover Provider
Art Dealer
Auction House
Audio Licensing/Sound Bite Provider
Cannabis-Related Products Seller
Car Wash
Caterer
Charitable Organizations
Children's Classes Provider
Clothing and/or Fashion Accessories Store
Coin/Precious Metal Dealer
Company Formation Services
Computer Software Seller
Consultancy Services Provider
Consumer Electronics Seller
Contractors/Construction Company
Cosmetic/Beauty Product Seller
COVID-19 Test Laboratory
Cruise Line Operator
Cyber-Locker Services Provider
Dating Services Provider
Debt Collection/Management Services Provider
Discount/Promotion Code Reseller
Driving Instructor
E-Book Subscription Seller
E-Commerce Marketplace
E-Wallet Operator
Escort Services Provider
Event Organiser
Financial Skill Games Platform
Fireworks Seller
Food Stall/Truck Vendor
Furniture/Home Furnishing Seller
Gambling Operator
Hairdresser and/or Beauty Salon
Heating/Plumbing/AirCon Contractor
Hobby, Toy, and Game Shops
Immigration Services Provider
In-Game/Virtual Goods Platform Operator
Insurance Services Provider
Legal Services Provider
Logistics & Delivery Services
Lottery Messenger
Lottery Syndicate
Medical Cannabis Producs Seller
Medical Services Provider
Mobile Phone Repair Services Provider
Money Remittance Services Provider
Mysticism /Divination Services Provider
NFT Marketplace
NFT Seller
Nootropics Seller
Nutraceutical Products Seller
Online Fan Engagement Platform Provider
Online Gambling Courses Provider
Online Gaming Platform Operator
Online News Outlet
Online Personal-Development Courses Provider
Online Professional Courses Provider
Online Trading Courses Provider
Payday Loans Provider
Personal Assistant/Concierge Services
Pet-Related Products Seller
Pharmaceuticals Seller
Photographer and/or Photographic Studio
Prize Competitions Operator
Professional Cleaning Services Provider
Proprietary Trading (PropTrading) Platform Operator
Psychedelics Seller
Real-Estate Broker
Restaurant
Securities Trading Operator
Sex-Dating Services Provider
Skill Games Operator
Smoking/Vaping Products Seller
Sporting Goods Store
Stock Image Seller
Supermarket/Grocery Store
Taxi/Limousine Operator
Technical Support Services Provider
Ticket Broker
Tour Operator
Travel Agency
Utilities/Telecommunications Services Provider
Vehicle Data Checking Service Provider
Vehicle Dealer/Seller
Vehicle Rental and/or Leasing Agent
Vehicle Repair Services Provider
Virtual Currency Exchange
Voucher/Gift Card Broker
Weapons Seller
Web Designer
Web Hosting Service Providers
Website Traffic Generator
11
Are you currently processing payments?* This field is required.i.e. accepting credit/debit cards in your business
Currently not processing
Yes, but less than 3 months
Yes, for more than 3 months
12
Who is your current provider?
13
Why do you want to replace your current provider?* This field is required.Please choose all reasons that apply!
Current provider’s service is unsatisfactory
Current account was terminated
Current provider is too expensive
Looking to add an additional provider
Other
14
Why do you want to change your current provider? ()* This field is required.
15
Is your business an e-commerce business?* This field is required.i.e. do you sell online?
Yes
No
Not yet, but there’s an intention to
16
To which platform is your website connected to/built with? * This field is required.
Please Select
Please Select
Leverate
WooCommerce
Magento
PayNetEasy
CommDoo
Coriunder
Worldline-Bambora (DevCode)
Praxis
BridgerPay
BitcoBrokers
Wix
PrestaShop
sticky.io
Konnektive
Checkout Champ
osCommerce
SoftGamings
Shopify
ShopWired
Shopware
Other
17
To which platform is your website connected to/built with? ()* This field is required.
18
How would you describe your average risk performance?* This field is required.
Chargeback ratio is between 1%-5%, but Fraud ratio is below 1%
Fraud and Chargeback ratios are below 1%
Fraud ratio is between 1%-5%, but Chargeback ratio is below 1%
Fraud and/or Chargeback ratio is above 5%
No information available
19
What is your current processing volume?* This field is required.monthly processing volume, NOT annual!
Currently not processing
Less than £10,000
£10,000-£50,000
£50,000-£100,000
£100,000-£500,000
£500,000-£1,000,000
More than £1,000,000
20
What solution(s) are you looking for?
Huge
Large
Normal
Small
Ok
Ok
21
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22
Form Channel
23
Form Source
24
Get Page URL
Should be Empty: