Bambora Merchant Application

Merchant Application

bambora
BUSINESS INFORMATION
Business Trading Name
Business Legal Name
NZBN Business Number
GST Number
Business Type
Business Category
Business Industry
Average Sale Amount
Annual Online Turnover
International Transactions %
PHYSICAL BUSINESS ADDRESS
Business Address
Region
Post Code
New Zealand
Phone Number

Area CodePhone Number
Email
example@example.com
Website
BANK DETAILS
Account Holder Name
Bank
Branch
Account
Suffix
MERCHANT FEES
Online Merchant Fees: 2.9% per transaction
DIRECTOR 1
Director 1 Name
Birth Date

MonthDayYear
Email
example@example.com
Position
Address

Street Address

Suburb

CityRegion

Post Code
Shareholder
Percentage Ownership
NZ Drivers License / Passport Number
NZ License Version Number / Passport Expiry Date
DECLARATION SIGNATURES
Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
- Director 2 Name
- Birth Date
  
  MonthDayYear
- Email
  example@example.com
- Position
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Shareholder
- Percentage Ownership
- NZ Drivers License / Passport Number
- NZ License Version Number / Passport Expiry Date
- DECLARATION SIGNATURES
- Signature:
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Director 3 Name
- Birth Date
  
  MonthDayYear
- Email
  example@example.com
- Position
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Shareholder
- Percentage Ownership
- NZ Drivers License / Passport Number
- NZ License Version Number / Passport Expiry Date
- DECLARATION SIGNATURES
- Signature:
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- SHAREHOLDER 1
  
  Please provide details for all controlling individual stakeholders. Not required if already provided as a Director.
- Shareholder 1 Name
- Birth Date
  
  MonthDayYear
- Email
  example@example.com
- Position
- Residential Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Shareholder
- Percentage Ownership
- NZ Drivers License / Passport Number
- NZ License Version Number / Passport Expiry Date
- DECLARATION SIGNATURES
- Signature:
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Shareholder 2 Name
- Birth Date
  
  MonthDayYear
- Email
  example@example.com
- Position
- Residential Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Shareholder
- Percentage Ownership
- NZ Drivers License / Passport Number
- NZ License Version Number / Passport Expiry Date
- DECLARATION SIGNATURES
- Signature:
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Shareholder 3 Name
- Birth Date
  
  MonthDayYear
- Email
  example@example.com
- Position
- Residential Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Shareholder
- Percentage Ownership
- NZ Drivers License / Passport Number
- NZ License Version Number / Passport Expiry Date
- DECLARATION SIGNATURES
- Signature:
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- DIRECT DEBIT AUTHORITY
  
  Please print following direct debit authority, fill out required fields and upload below to complete Bambora Merchant Application
- Upload Signed Copy of Direct Debit
  
  Browse Files
  
  Cancelof
- Should be Empty:

Merchant Application

SHAREHOLDER 1

DIRECT DEBIT AUTHORITY