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Apply Merchant
Apply Merchant
Merchant Service Form
Lead Director
First Name
*
This field is required.
Last Name
*
This field is required.
Date of Birth
*
This field is required.
Citizenship
*
This field is required.
Home Address
*
This field is required.
City
*
This field is required.
ZIP / Postal Code
*
This field is required.
Phone Number
*
This field is required.
Email
*
This field is required.
Position
*
This field is required.
Shareholding
*
This field is required.
Business Details
Registered Name
*
This field is required.
Registered Address
*
This field is required.
City
*
This field is required.
Post Code
*
This field is required.
Start Date
*
This field is required.
Check, if you have the same trading name and address.
Trading Name
*
This field is required.
Trading Address
*
This field is required.
City
*
This field is required.
Post Code
*
This field is required.
VAT Registered?
*
Yes
No
VAT Number
*
This field is required.
Recently taken over the business?
*
Yes
No
Acquisition Date
*
This field is required.
About Your Business
Estimated Turnover (Monthly)
Card Transaction Turnover (%)
Estimated Average Transaction Value
Card Present (%)
Highest Possible Transaction
Card Not Present (%)
Goods and Services Offered (%)
Website / Social Link
*
This field is required.
Submit
