Application Form for Shift4
Barry Rafferty
Business Legal Name (Or Name of Person if Sole Trader)
Trading As:
Name
First Name
Last Name
Position within Company
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Trading Address
Street Address
Street Address Line 2
City
County
Postal / Eir Code
Date of Incorporation
(Date Day/Month/Year, Start date of trading)
Company Registration Number
(If Applicable)
Type of Business
Please Select
Limited Company
Partnership
Sole Trader
Vat Number
(If Applicable)
Website Address
(If Applicable)
Sole Trader Home Address
Street Address
Street Address Line 2
City
County
Postal / Eir Code
Date of Birth
Day/Month/Year
Type of Terminal
SkyTab Sole
SkyTab POS
Currently Rate Being Charged e.g 1.75%-2.65%
Do You Take Card Not Present Payments?
Please Select
Yes
No
Estimate Average Transaction Amount:
Estimated Monthly Turn Over:
Proof Of ID
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Passport, Driving Licence, Public Services Card
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Proof Of Address /Eircode Photo
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Utility Bill (Screenshot Accepted)
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Proof Of Business, please upload a picture of the Outside & Inside of your business
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Bank Statement (Please ensure the top of your Statement id Clearly Visible, Bank Logo, Name, Address, BIC & IBAN)
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Proof of Home Address
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Needs to be Dated within the last 3 Months
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Submit
Should be Empty: