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Merchant Pre-Approval Form

General Information

Please provide the following information

1. Company Registered Name:(Required)

2. DBA (doing business as) name(Required)

3. Company Registered Address, Country of incorporation, and Company Registered Number(Required)

4. Years in business(Required)

5. Provide name(s) of your current payment processor(s):(Required)

6. Describe in detail the product or service you are selling:(Required)

7. Provide ur website URL(s) where you process online payments:(Required)

8. Describe the pricing model of your product or service (high ticket, average ticket, subscription...):(Required)

9. Describe your product or service marketing − How is traffic driven to website?(Required)

10. Which markets do you intend to sell into, and which currencies do you require?(Required)

11. What are your current monthly sales, and do you intend to keep or replace your current processing solution(s)(Required)

12. Desired monthly volume cap for a new merchant account(Required)

13. Describe your current chargeback performance − average chargeback count and percentage per month(Required)

14. Current pain points special requirements − help us better understand your business challenges and needs:(Required)

Please provide your contact details

Full Name(Required)

First Last

Email(Required)

Phone(Required)

CAPTCHA

Concent(Required)

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