REAL ACCOUNT APPLICATION FORM

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1 REAL ACCOUNT APPLICATION FORM To use the MasterCard Payment Gateway you must have a Merchant ID number for e-commerce with one of the Acquiring Banks that we connect to. To use the MasterCard Payment Gateway Services Direct Debit service you must have an Originator ID number that has been issued by your Sponsoring Bank. Please allow 10 minutes to complete this application. If you have any further enquiries please contact our Sales Team on Fields marked in BOLD are mandatory. We are unable to process your application if you send us incomplete information. Please do not submit this form until you have a merchant ID Number / Originator ID Number. Fields marked in BOLD are mandatory Tel: +44 (0) Web: 1

2 1. COMPANY DETAILS 2. CONTACT DETAILS Company Name: Contact Name: Trading as: Job Title: (If different from above) Address: Work Telephone: Mobile: Country: General Postcode: Technical VAT No: Registration No: Are you an existing MasterCard Payment Gateway Services Customer? YES NO Tel: +44 (0) Web: 2

3 3. BILLING DETAILS Contact Name: 4. SERVICES Please tick the Value Added Services that you require: FRAUD PREVENTION Telephone: Address: Real Time Fraud Screening 3-D Secure Age Identity Verification Bin Range Restriction Ceiling Limits RECURRING TRANSACTIONS Credit / Debit Card Continuous Authority Country: Direct Debit Continuous Authority Postcode: TOKENIZATION SOLUTIONS Payment Tokenization (Pre-Registered Card) Card Tokenization Tel: +44 (0) Web: 3

4 4. SERVICES (CONT.) 5. DIRECT DEBIT & DIRECT CREDITS ADDITIONAL CARD TYPES American Express Corporate Purchasing Cards Visa Electron Laser Diners YES, I require the Direct Debit Service YES, I require the Direct Credit Service Originator ID No (OIN): Sponsoring Bank: OIN Type: PREPAY SOLUTIONS AUDDIS AUDDIS PAPERLESS e-vouchers Online cash transactions Please supply one address in which the electronic notification(s) should be sent. OTHER SERVICES Transax Cheque Guarantee Batch Processing To ensure that you receive electronic notification of failed DD setups, please make sure you have completed section 6 of the BACSTEL IP form from your sponsoring bank. Split Shipment Chargeback Management e-wallet Solutions Dynamic Currency Conversion MasterPass Tel: +44 (0) Web: 4

5 6. MID REQUIREMENTS Please enter your Merchant ID Number(s), given to you by your acquiring bank, for e-commerce and/or Mail / Telephone Order (if applicable). Enter the 3 digit currency code in the boxes below that you wish to trade and settle in. Please confirm whether your MID is being used for Gaming authorisations (SIC: 7995) YES NO Please confirm which country your MID is registered to? MERCHANT ID NUMBER MID TYPE TRADE IN SETTLE IN ACQUIRING BANK MERCHANT CATEGORY CODE (MCC) COUNTRY CODE Further requirements: Tel: +44 (0) Web: 5

6 6. MID REQUIREMENTS (CONT.) Bank account in which the monies are to be settled. Bank Name: Bank Address: 7. MASTERCARD PAYMENT GATEWAY SERVICES ANNOUNCEMENTS MasterCard Payment Gateway Services announcements are sent in the event of any changes occurring that may affect the service you receive from MasterCard Payment Gateway Services, its partners or acquiring banks used. This will include details of system status updates and scheduled maintenance notifications. It is recommended that you set up a mailing list at your company of the form: com' with all interested parties subscribed. This ensures that announcements will be received even if a key member of staff is not available. Sort Code: Account Number: This information will be used solely for the purpose of informing you of important operational information, and will not be used for marketing purposes. Purchase Order: YES I would like to receive MasterCard Payment Gateway Services announcements to the following address: NO I do not wish to receive MasterCard Payment Gateway Services announcements Tel: +44 (0) Web: 6

7 8. TECHNICAL INFORMATION From which IP Address will you submit transactions to MasterCard Payment Gateway Services? E-Commerce website: 9. MASTERCARD PAYMENT GATEWAY SERVICES REPORTING SYSTEM Please supply details of the person who will administer MasterCard Payment Gateway Services Reporting Accounts for your organisation. IP Address to access Reporting: Description of products/services you will be selling via the account: Reporting Username: (Alphanumeric Characters only, max 20) Forename: Surname: Address: Telephone Number: Tel: +44 (0) Web: 7

8 10. ADDITIONAL INFORMATION 11. CONFIRMATION How did you find MasterCard Payment Gateway Services? From existing customer (*) Bank recommendation (*) IBS Software Services (P) Ltd Please do not submit this form until you have a Merchant ID Number. I hereby declare the above information to be true and complete Please enter your name here: Telesales / Sales Call Search Engine / website Reseller (*) Other If other or marked (*) please specify Your Comments: Tel: +44 (0) Web: 8

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