Grants Payment | Merchant Register

1 Bio Data
2 Corporate Information
3 Company owners information
4 Merchant information
5 Contact information
6 Processing information
7 Processing history

Company legal name:

Company registration number:

Legal form:

Merchant description DBA (doing business as):

Merchant website URL:

(http://url.com)

Description of products or services:

How many years in this business:

If applicable what kind of business has the merchant been in before:

Company registered address

Address:

City:

Zip / Postal code:

Country

Phone

Fax:

E-mail:

Company physical location

If the physical location is different to registration address, please enter.

Address:

City:

Zip / Postal code:

Country

Other physical locations:

Number of employees:

Date established:

(dd/mm/yyyy)

Total number of owners:

The largest share owner

Full name:

Age:

Number of years spent within the company:

Address:

City:

Zip/postal code:

Country:

Phone:

The second largest share owner

Full name:

Age:

Number of years spent within the company:

Address:

City:

Zip/postal code:

Country:

Phone:

The third largest share owner

Full name:

Age:

Number of years spent within the company:

Address:

City:

Zip/postal code:

Country:

Phone:

Other owners

If other owners, please enter:

Company director information

Full name:

Age:

Number of years spent within the company:

Address:

City:

Zip/postal code:

Country:

Phone:

If the merchant name or address is different from company, please enter.

Name:

Address:

City:

Zip/postal code:

Country:

Total number of merchant locations:

Location address 1

Address:

City:

Zip/postal code:

Country:

Location address 2

Address:

City:

Zip/postal code:

Country:

Location address 3

Address:

City:

Zip/postal code:

Country:

Primary contact

Full name:

Position:

Address:

City:

Zip/postal code:

Country:

Phone:

Fax:

E-mail:

Dispute contact

E-mail:

Business information

Total revenue of the company per year:

USD

Total revenue of the merchant per year:

USD

Domestic	%
European	%
American	%
Other	%

Visa	%
MasterCard	%
VISA Electron	%
Maestro	%
Union Pay	%

Card present	%
MOTO (mail or telephone order)	%
E-commerce	%
Recurring	%

Spring	%
Summer	%
Autumn	%
Winter	%

Apply for a Merchant Account

Company registered address

Company physical location

The largest share owner

The second largest share owner

The third largest share owner

Other owners

Company director information

Location address 1

Location address 2

Location address 3

Primary contact

Dispute contact

Business information

Chargeback information

Bank account information

Primary bank account

Bank personnel contact

Merchant documentation checklist

Fraud prevention checklist

Web site check

Consumer cards	%
Commercial cards	%