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  1. 1. Contact Information
  2. 2. Merchant Information
  3. 3. Merchant Facility
  4. 4. Payment Options
  5. 5. Further Information

Business Information













Contact Information



Director/Proprietor Signatory

(If applicable, please indicate more than one)



Director/Proprietor Signatory 2

(If applicable, please indicate more than one)



Director/Proprietor Signatory 3

(If applicable, please indicate more than one)



Director/Proprietor Signatory 4

(If applicable, please indicate more than one)



Merchant/Business Information



* Mail Order/Telephone Order
* Prepayments


* Do you have a refund/return policy?
* Do you have terms & conditions?

Online Merchant Facility

Do you have an Online Merchant Facility?

Settlement Account Details



* Use Settlement Account as Billing Account?

Payment Gateway Options

* Accepted Currency

* Do you have an American Express Merchant ID?

* Do you have a Diners Club Merchant ID?

* Do you have a UnionPay Merchant ID?

Further Information


Do you have any other businesses?

Thank you for providing this information.
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