Merchant services application form

1. Application Details
First Name*
Phone Number*
How will payments be taken?*
2. Business Details
Company Structure
How did you hear about us?
What is the registered company name?*
Trading name if different from companies house
Address Line 1
Address Line 2
Region / State / County
Post Code / Zip
Is your trading address different to your registered office?
Trading Address
Address Line 1
Address Line 2
Region / State / County
Post Code / Zip
VAT Number (if registered)
Tax ID / UTR Number of business
Source of income*
Business category
3. Website Details
Website URL
Do your website have a login area?*
Login Page URL
4. Card Processing Details
Estimated monthly turnover (through card payments)
What is your average transaction value for your product or service?
What is the highest value you would expect to pay on card?
How regular would your customers pay for your goods or services?
Do you process subscription or recurring business?*
Do you already accept card payments?
Do you have a history of chargebacks? If so, no. Of chargebacks per month
Do you have regular refunds? If so, % of turnover is refunds?
Do you trade overseas?
State the countries you trade with and approx levels of turnover
What is the average timeframe fro the product been bought and delivered? (0 days if paid on delivery)
5. POS machine delivery details
Number of terminals required?
Number of charging bases?
Number of Sim cards if operating with GPRS?
Type of terminal
Is delivery address the same as trading address?
Delivery Address
First Name
Last Name
Address Line 1
Address Line 2
State / Region / County
Post / Zip Code
Phone Number
6. Settlement details
Please upload a photo of a blank cheque or bank statement
Maximum file size: 32 MB
Company name (Beneficiary)
Sort Code
Account number
Bank Name
7. Director/Owner Detail
Add a Director
You haven't filled in all the fields. Please enter all required information and try again.
8. Correspondence information / email contact
Would you like all email correspondence to go to the main contact initially?
Preferred email for merchant statements
Email for disputes
Email for risk/fraud
Email for detail transaction reports

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