Business Overview
Website URL"s
Descriptor
City Field (CS #)
Username
Password
Website URL 2
Descriptor
City Field (CS #)
Password
Username
Website URL 3
Descriptor
City Field (CS #)
Username
Password
Business Model Description
Processing Information
Projected Monthly Turnover
Projected Monthly Number of Txns
Average Transaction Value
Min/ Max Transaction Value
Average Chargeback Ratio
Average Fraud Ratio
Target Markets
Top 5 customer countries (with % split):
EU/ EEA (%)
UK(%)
North America(%)
Asia (%)
RoW (%)
If No, please specify the relationship with the domain owner
If Yes, please specify Country of Issuing Authority
If Yes, please specify the third party gateway you are using (if any)
What is the Company’s main source of wealth? (Initial source of wealth when the company was established)
COMPANY INFORMATION
Legal Information
Company Legal Name
Registration No
Tax ID / VAT No
Company Phone No
Company Email ID
Registered Address
Street, House No
Postcode, City
Country
Operating Address
Street, House No
Postcode, City
Country
Director(s)/ Authorized Signatory(ies)
First name, Last name/ Company name (if a legal entity)
Country of Residence/ Incorporation
E-mail address
Phone number
First name, Last name
Country of Residence/ Incorporation
E-mail address
Phone Number
First name, Last name/ Company name (if a legal entity)
Country of Residence/ Incorporation
E-mail address
Phone No
Shareholder(s) (> 25% shares)
First name, Last name / Company name (if a legal entity)
Country of Residence
E-mail address
Phone Number
First name, Last name / Company name (if a legal entity)
Country of Residence
E-mail address
Phone Number
First name, Last name / Company name (if a legal entity)
Country of Residence
Email address
Phone Number
Ultimate Beneficial Owner(s)
First name, Last name
Country of Residence
E-mail address
% of Ownership
First name, Last name
Country of Residence
E-mail address
% of Ownership
First name, Last name
Country of Residence
E-mail address
% of Ownership
REQUIRED SETUP
SETTLEMENT BANK ACCOUNT
Beneficiary Name
Bank Name
Bank Address
SWIFT/ BIC
IBAN/ Account Number
Account Currency
CONTACT DETAILS
Main Contact
First name, Last name
Phone Number
Business title
E-Mail Id
Technical Contact
First name, Last name
Phone No
Business title
E-mail
Email for chargeback & fraud notifications
Provide SAQ D along with valid PCI scans
Email for settlement reports
REQUIRED DOCUMENTS
Certificate of Incorporation
Certificate(s) showing registered address, the current directors, and current shareholders of the Company
Memorandum and Articles of Association
Proof of ID (copy of passport or ID card) of all directors, authorized signatories, shareholders and beneficial owners holding more than 25% of shares (must be a color copy)
Proof of residential address (utility bill, personal bank/ credit card statement) of all directors, authorized signatories, shareholders and beneficial owners holding more than 25% of shares (less than 3 months old)
Proof of trading address (utility bill or a rental agreement in the name of the Company)
Proof of domain ownership
Copy of business license (if applicable)
Last 6 months processing statements bearing the processor’s logo and the Company’s name and/or URL, and showing sales volume and transaction count, refund volume and count, chargeback volume and count.
Bank account statement in the name of the Company showing full settlement bank account details (less than 3 months old)
Any other supporting documentation (fulfillment agreement, etc.)
NOTE:
The information supplied in this application will be used to determine the best solution for your payment processing needs so please ensure it is true, accurate and complete. Please also be advised that eDataPay Payments may disclose the information provided above to acquiring banks and third-party service providers (such as identity verification service providers, etc.) for the purpose of opening a merchant account.
Completion of this form does not create contractual relations between the parties.
Referred By
