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Merchant Application Form: Company Information

This document is a merchant application form for a company seeking to accept credit card payments. It requests information in several sections, including company details, website information, manager details, customer service contact, processing history, ownership breakdown, transaction volume estimates, bank account information, business description, and website requirements. The form must be digitally filled out and submitted for review.

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Herbert
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185 views4 pages

Merchant Application Form: Company Information

This document is a merchant application form for a company seeking to accept credit card payments. It requests information in several sections, including company details, website information, manager details, customer service contact, processing history, ownership breakdown, transaction volume estimates, bank account information, business description, and website requirements. The form must be digitally filled out and submitted for review.

Uploaded by

Herbert
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Merchant Application Form

(Application form must be digitally filled; Hand Written form will not be accepted)

Company Information

Company Name
Company Address
Company City/Town
Company State
Company Zip Code
Company Country
Target Countries

Website Information

Website URL
Products/Services
Descriptor (This will show to the
bank statement of your customer)

Manager Information

Full Name
Address
City/Town
State
Zip Code
Country
Cell Phone
Alternate Phone
Email Address (will serve as the Username)
Alternate Email Address

Customer Service Information

Contact Name
Toll Free Number
Contact Email

Processing History

Do you currently accept credit cards (If yes then at what TDR?) Yes No
Have you ever processed before Yes No
Have you ever had merchant account terminated Yes No
If yes please state the reason
Former/Current Processor
Time with Processor

Ownership Information (This must be equal to 100% Share)

Full Name (Owner 1)


Ownership Share (%)
Address
City/Town
State & Zip Code
Email
Cell Phone

Owner 2:

Full Name (Owner 2)


Ownership Share (%)
Address
City/Town
State & Zip Code
Email
Cell Phone

Owner 3:

Full Name (Owner 3)


Ownership Share (%)
Address
City/Town
State & Zip Code
Email
Cell Phone

Owner 4:

Full Name (Owner 4)


Ownership Share (%)
Address
City/Town
State & Zip Code
Email
Cell Phone

You May add or remove this section based on your company ownership. Please note we must get 100%
ownership details of your business.
Transaction Information

Estimated total sales/month Number of transactions/month


Minimum ticket amount Maximum ticket amount

BANK INFORMATION (Should be Under the Company Name)

Account Holder Name:

Account Holder Address:

Account Holder Country:

Bank Name:

Bank Address:

Bank Country:

Bank SWIFT/Routing/IBAN :

Bank Account Number:

General Information

Describe your line of business (products/services being sold)

Describe briefly the operations involved from the customer's order to the product/service delivery and the time
schedules involved to fulfill the order.

Describe briefly the marketing activities undertaken to generate sales


WEBSITE REQUIREMENTS Response

Complete description of goods and services on website? (Yes/No)

Price displayed? (Yes/No)

Does the sponsored merchant state that it will attend to customer


service request within 2 working days? (Yes/No)

The address of the company is on the site? (Yes/No)

Company contact details for Customer Support are clearly displayed


(Yes/No)

Customer Service Toll free number displayed on the site? (Yes/No)

What types of customer service do you offer? (In-house/Outsourced)

Terms & Condition, Privacy Policy on website? (Yes/No)

Return, refund, and cancellation policy on website? (Yes/No)

Site/Payment Page is SSL Secured (https)? (Yes/No)

A procedure regarding the return of goods/services is displayed?


(Yes/No)

Are sales generated through outbound telemarketing? (Yes/No)

Content on web site is provided by- (Self/Third-party)

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