Payment Gateway Sign Up

If you require any assistance, please contact us on 1800 723 327 or [email protected]

1. BUSINESS DETAILS
2. ACCOUNT DETAILS
3. MERCHANT/BUSINESS INFORMATION
4. CONTACT DETAILS
5. OTHER INFORMATION REQUIRED

BUSINESS DETAILS

* Legal Entity Name
* ABN/ACN Number
* Trading Name
* Trading Address
* Postcode
* Trading Phone Number
Trading Fax Number

* Mailing Name
* Mailing Address (street)
* Mailing Address (suburb)
* Mailing Postcode
* Mailing Phone Number
Mailing Fax Number
* Email Address
* Web Address

Online Merchant Facility

Merchant ID:

Terminal ID:

Settlement Account Details*

(This is where the money goes prior to moving into your business bank account.)

* Account Name:

* BSB:

* Account Number:

Billing Account*

(This is your preferred business bank account)

BSB:

Account Number:

Merchant/Business Information

(Existing Merchants please provide copies of at least 3 months merchant statements.
New merchants, if actual figures are not available, please provide your most accurate estimate)

* Total Yearly Turnover $ includes cash, cheques, cards, etc

* Credit Card Sales % Only include Visa/Mastercard/Bank card in %. No Amex or Diners

Average Value per Transaction $

* Mail Order/Telephone Order Accepting payments over the phone or through the mail.

YESNO

* Prepayments Where the goods or services are not deliverd in full until after the credit card transaction is processed

YESNO

If yes, how much per week:

If applicable, % of credit card sales where prepayment is made:

Average Delivery Terms How many days after processing the payment are goods/services delivered?

How many days after processing the payment are goods/services delivered?

Contact Information

* First Name
* Last Name

* Mobile Number
* Email Address

Director/Proprietor Signatory

(If applicable, please indicate more than one)

* Full Name
* Date of Birth
* Phone Number
Fax Number

Director/Proprietor Signatory 2

(If applicable, please indicate more than one)

FullName
Date of Birth
Phone Number
Fax Number

Director/Proprietor Signatory 3

(If applicable, please indicate more than one)

Full Name
Date of Birth
Phone Number
Fax Number

Director/Proprietor Signatory 4

(If applicable, please indicate more than one)

Full Name
Date of Birth
Phone Number
Fax Number

Other informations

* Do you wish to offer cash out?

YESNO

* Will you be accepting AMEX?

YESNO

If yes, AMEX Merchant Number:

* Will you be accepting Diners?

YESNO

If yes, Diners Merchant Number:

* Will you be accepting CUP?

YESNO

If yes, CUP Merchant Number:

Thank you for providing this information.
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Payment Gateway Sign Up

BUSINESS DETAILS

Online Merchant Facility

Settlement Account Details*

Billing Account*

Merchant/Business Information

Contact Information

Director/Proprietor Signatory

Director/Proprietor Signatory 2

Director/Proprietor Signatory 3

Director/Proprietor Signatory 4

Other informations

What are you looking for?

If you’d like to call us direct, you can reach us at
1800 723 327 Mon – Fri 9am – 5pm AEST