Merchant Application Form

Transcription

1 emerchantpay Limited Merchant Application Form Hand written applications will not be accepted.

2 CORPORATION DETAILS European Company Details n-european Company Details If applicable Company Registration Number: Legal name of company: Registered address: Post code and city: Country: Primary Contact person- Name, phone number, fax and BANK ACCOUNT INFORMATION Settlement Bank Account Settlements to be made in the following bank account: Owner of account: Bank name: Bank contact person: Bank address: Bank tel/fax: SWIFT code: Account number: Account currency: IBAN: Page 1

3 WEBSITE DETAILS Applicant website/s: Login Details: User ID: Password: Type of Business: Descriptor: (merchant name to appear on credit card statement) IP Address: City Filed: (customer service phone number) Customer Support Chargeback notification How long have you been in business: Previous/ current name of processor and/or acquirer: Current monthly sales volume: Current number of monthly transactions: Desired processing currencies: EUR USD Desired settlement currencies: EUR USD GBP GBP Other:... Other:... Do you use payment methods other than credit cards? Please specify: Other:... Do you preauthorize card transactions: Page 2

4 PROCESSING DETAILS Reason for applying for this merchant account: MOTO (Mail Order, Telephone Order) account needed: Projected monthly processing volume: Projected monthly number of transactions: How do you receive your customer`s orders: Internet/ SSL Order (%): Telephone Order (%): Volume divided between cardholders: Domestic (%): European (%): Other (%): US (%): Volume divided between card types: Consumer Cards (%): Commercial Cards (%): Server to server integration requested (it is permitted solely at discretion of the processor): Name of Gateway: Use of fraud prevention techniques: Specify: If you block any countries for transactions, please specify: Specify: Page 3

5 BENEFICIAL OWNERS Please start with the largest shareholder Beneficial Owner # 1 Beneficial Owner # 2 Beneficial Owner # 3 First Name: Last Name: Address: Phone Number: Current home address: City and ZIP: Country: Passport Number: % Ownership: DIRECTOR(S) Director # 1 Director # 2 Director # 3 First Name: Last Name: Address: Phone Number: Current home address: City and ZIP: Country: Passport Number: Page 4

6 MERCHANT TECHNICAL CONTACT Name: Phone number & fax: address: INTEGRATOR TECHNICAL CONTACT Name: Phone number & fax: address: FINANCIAL CONTACT (ACCOUNT/ BILLING) Name: Phone number & fax: address: Page 5

7 WEBSITE CONTENT What is/ are the product/s or services sold on your website? Please specify the payment model (recurring, one-time payment, pay-per-minute, etc): What the cardholder will be paying for through your website: When is the customer charged for purchase (upon placing an order, when the order is shipped, upon receipt): Please specify the major countries your customers are from: Do you send an receipt to the cardholder when the product has been fulfilled? If yes, please us sample/s. Do you distribute any materials and/ or agreements to customers; related to the services offered? If yes, please us sample/s. Do you have an appropriate business license for your business (ex. Pharmaceutical license for your company or your supplier`s license; gaming license)? If yes, please provide us with a copy. Does your company fulfil orders directly? If no, please provide fulfilment company information details: Specify: Do you operate any affiliate programmes? Are they involved in the processing on your website: Specify: Page 6

8 REQUIRED DOCUMENTS Incorporation documents: 1. Certificate of Incorporation for the Applying Company issued by the Company Registrar. * 2. Memorandum and Articles of Association for the Applying Company issued by the Company Registrar. * 3. Certificates listing the current directors, current shareholders and registered address of the Applying Company issued by the Company Registrar. * Personal information: 1. Passport Copies for the directors and beneficial owners and authorized signatories signing documents on behalf of the Applying Company. * 2. Original utility bill, personal bank statement or credit card statement (less than three months old), for address verification for each of the directors, beneficial owners and authorized signatories signing documents on behalf of the Applying Company.* In case of an Overlying Company(s) stated in the above mentioned corporate documents, please provide all documents listed in points 1 and 2 for it (them). * Processing statements or screenshots of current processing history showing the Applying Company s last 6 months monthly sales, chargebacks and refunds with volumes and counts included. ** 1. If there are any indications of elevated chargeback ratios, please provide an explanation as well as a chargeback reduction plan.* 2. If the applying business is a start-up and processing history is not available, please provide a detailed business plan including projected 000volumes, target markets and marketing strategies. * Most recent company bank statement or audited financial statements accompanied by a void check/bank letter validating the financial stability and confirming full settlement bank account details of the Applying/Overlying Company. * Declaration Letter signed by the beneficial owner of the Applying Company. * Copy of an operating license (if applicable - e.g. pharmaceutical license, gaming license, etc.) of the Applying Company. * * Original required upon approval. If original not available, certified copy of the original document authenticated by a tary Public, Attorney, Public Accountant or Consular Official to be a true copy of the original document is required. ** Digital Scan copy or print screens are sufficient. PLEASE NOTE THAT ADDITIONAL DOCUMENTS MAY BE REQUIRED THROUGHOUT THE APPLICATION PROCESS DEPENDING ON THE PARTICULAR SOLUTION. TRANSLATION OF DOCUMENTS MAY BE REQUIRED IF LANGUAGE IS DIFFERENT FROM ENGLISH. DISCLAIMER: Please note that completion of this form will not bind either emerchantpay Limited or any of our acquirers to any particular course of action and submitting of the information requested in this form shall explicitly not create contractual relations between parties. Page 7