Application Form
Ownership Type
*
Please Select
Individual
Partnership
LTD
LLP
Charity
Legal Name
*
Company Number
Trading Name
*
Registered Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your Trading Address the same as Registered Address
*
Yes
No
Business Location (if different than Registered address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When was your business started?
*
-
Day
-
Month
Year
Date
Business Area
Residental Area
High Street
Shopping Ctr
Industrial Building
Work from Home
Website Address
Upload KYB Pictures of Outside
Upload KYB Pictures of inside please
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Principal Information
Please list all principals who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, own 25% or more of the equity interests of the legal entity listed in this application.
Title
*
Please Select
Chairman
Director
Office Manager
Owner
Partner
President
Treasurer
Owner Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Driving Licence Front
Driving Licence BACK
Passport
Mobile Phone Number Personal
*
-
Area Code
Phone Number
Business Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Ownership %
*
if not 100% please add extra detials in Notes box below
Extra Share holders details please send KYC via email
Have you (your business or any principal) filed or been made bankrupt?
Yes
No
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Business Information
This section pertains to information about your business’s for wherecredit card processing will be completed
Does this business currently accept credit cards?
Yes
No
Does this business currently accept Amex?
Yes
No
Amex MID
PLEASE UPLOAD A PICTURE OF STATEMENT
Current Aquirer
Please Select
Barclays
World Pay
Global Payments
Take Payments
Elavon
Dojo
Stripe / Square
Other
Monthly Volumes Cards
*
Average Transaction Amount
*
Max Single Transaction Amount
*
Describe your product/service.
*
Primary Sales Method
In-person (card present)
Mail/Phone (card not present)
Internet/eCommerce (card not present)
Percentage of Sales from UK Customers
Percentage of Sales from EU Customers
Percentage of Sales from International Customers
Stock Held
On-Site
Off-Site (i.e. Warehouse)
3rd Party Fulfillment Center
Are there any other companies involved in shipping or fulfilling products/services (i.e. fulfillment center)?
Yes
No
Do you offer recurring and time-extended services (subscriptions, memberships, recurring plans, etc.)?
Yes
No
Details
Terminal Offers
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( X )
Pax A920 Pro 3 Year Offer
£18.00
£
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pax A920 Pro 2 Year Offer
£22.00
£
22.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pax A920 Charging Base
Free
£
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Sim Card
£2.50
£
2.50
Quantity
1
2
3
4
5
6
7
8
9
10
Prefered Settlement Type
Gross Settlemets
Net Settlemets
Prefered Settlement Times
T+1 30p Fee per day Monday to Friday
T+3 Free
Bank Account Number
*
Sort Code
*
Name on Bank Account
*
Upload POB
Switcher Staement if availabe
Personal Debit UK %
Personal Credit UK %
Business Debit UK %
Business Credit UK %
CNP Uplift %
Auth Fee
Refund Fee £
Submit
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